Abstract 15917: Echocardiographic Evidence of Cardiac Tamponade in Patients With Pulmonary Arterial Hypertension
Introduction: Pulmonary arterial hypertension (PAH) is a progressive disease of pulmonary arterial remodeling and right ventricular dysfunction, and is infrequently associated with pericardial effusion. High right-sided intracardiac pressures can obscure typical echocardiographic (echo) features of cardiac tamponade. Limited data published to date suggest high early mortality after pericardiocentesis in PAH.
Hypothesis: We hypothesized that echo evidence of tamponade in PAH rely predominantly on left sided findings. We also hypothesized that echo-guided pericardiocentesis is safe and effective in this setting.
Methods: Review of all patients with PAH evaluated at a Pulmonary Hypertension Clinic between 1/1/1995 and 12/31/2005. All patients had 2D and Doppler transthoracic echocardiography. Echo-guided pericardiocentesis in select PAH patients was performed with moderate sedation in a monitored inpatient setting.
Results: Of 575 PAH patients, 22 had moderate or greater pericardial effusions at diagnosis; 14/22 had clinical and echocardiographic evidence of tamponade. All 14 patients had recent clinical deterioration and elevated heart rates (101±12 bpm) with low to normal blood pressures (106 ± 17/63 ± 12 mm Hg). Echo demonstrated large effusions (max. fluid dimension in diastole 29 mm (range 18–50)); all had >25% respiratory variation in early mitral inflow systolic velocities; 8/14 had left atrial free wall collapse; 5/14 had right atrial (0/14 right ventricular) free wall collapse; 8/14 diastolic expiratory flow reversals in hepatic veins. All 14 had uncomplicated drainage of pericardial fluid (832 ± 512 cc). All effusions were serous (450 ± 553 cells/μl). No patient had clinical or echo evidence of acute RV dilation/dysfunction post-procedure. 13/14 had symptomatic improvement after pericardiocentesis.
Conclusions: Cardiac tamponade is rare in patients with PAH. Typical echo features of RV chamber collapse are often absent. Respiratory variation in mitral inflow, hepatic vein Doppler and left atrial collapse are still useful echo indicators of the hemodynamically significant effusion causing tamponade. Echo-guided pericardiocentesis is safe and effective in PAH patients with tamponade.
- © 2010 by American Heart Association, Inc.