Low cardiac output complicating pericardiectomy for pericardial tamponade

Neoplastic involvement of the pericardium resulting in an effusion and subs equent tamponade is an emergency requiring prompt decompression, generally safely accomplished by subxiphoid pericardiectomy. However, the current cas e report describes a patient with florid pericardial tamponade who underwen t surgical decompression with transient hemodynamic improvement, who then r apidly developed progressive, heart failure and death. This paradoxical res ponse to pericardial decompression, similar to that seen occasionally with pericardiectomy in constrictive pericarditis, may be more frequent than cur rently appreciated. Its cause may relate to the sudden removal of the chron ic external ventricular support from the effusion resulting in ventricular dilatation and failure. (C) 1999 by The Society of Thoracic Surgeons.