Constrictive Pericarditis After Pericardiocentesis

All interventional cardiologists must be able to perform a pericardiocentesis. Whether we deal with a chronic total occlusion, a supposedly simple coronary angioplasty (we all have witnessed the perforation of a supposedly risk-free coronary artery), or a transcatheter aortic valve replacement (whose rise gave us another significant source of tamponades), we must all be ready to face this problem.

With common sense, we considered as good practice a “lavage” with saline solution after complete drainage of effusions, so as to reduce the likelihood of constrictive pericarditis. Our conduct was absolutely empirical, since we aimed to reduce the likelihood of a complication whose incidence we ignored.

This study included a large cohort of non-selected patients who underwent pericardiocentesis. Among them, 16% experienced constrictive pericarditis. The long-term prognosis of these patients was very good and pericardiectomy was rarely required.

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Constrictive pericarditis is characterized by the co-existence of tense effusion and constriction of the heart by the visceral pericardium.

A total of 205 consecutive patients undergoing pericardiocentesis at Mayo Clinic were divided into two groups based on the presence or absence of echocardiographic findings compatible with constrictive pericarditis after drainage.

Constrictive pericarditis was diagnosed in 33 patients (16%) after pericardiocentesis.

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Tamponade was clinically evident in and affected 52% of patients with constrictive pericarditis vs. 36% of those who did not present constrictive pericarditis (p = 0.08).

Hemopericardium was more frequent in patients with constrictive pericarditis (33% vs. 13%; p = 0,003). Certain echocardiographic findings, such as respiratory variation of mitral inflow velocity, expiratory diastolic flow reversal of hepatic vein, and respirophasic septal shift were predictors of constrictive pericarditis.

There were 4 deaths in the group of patients with constrictive pericarditis, although all of them had known history of malignancies at the time of diagnosis.

During a mean follow-up of 3.8 years (range: 0.5 to 8.3), only 2 patients required pericardiectomy for persistent constrictive symptoms.

Conclusion

In this large cohort of non-selected patients who required pericardiocentesis, 16% of subjects experienced constrictive pericarditis. The long-term prognosis for these patients is good and pericardiectomy is rarely required.

Original title: Effusive-Constrictive Pericarditis After Pericardiocentesis: Incidence, Associated Findings, and Natural History.

Reference: Kye Hun Kim et al. J Am Coll Cardiol Img 2018. Article in press.

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