Key result
Thoracentesis resolves cardiac tamponade from large pleural effusion without pericardiocentesis in a post-MVR patient.
Why the study?
Mechanical, extracardiac compression by large pleural effusions can impair cardiac filling and cause hemodynamic changes consistent with cardiac tamponade.
This case highlights that large pleural effusions can cause extracardiac compression resulting in tamponade physiology, which can be resolved with thoracentesis alone.
Pleural effusions may cause reversible tamponade post-valve surgery; hypothesis-generating and leaves open prospective validation before practice change.
Mechanical, extracardiac compression by large pleural effusions can impair cardiac filling and cause hemodynamic changes consistent with cardiac tamponade. In this case, a 68-year-old woman presented with fatigue and mild dyspnea on exertion one month following bioprosthetic mitral valve replacement for severe mitral regurgitation. Initial examination revealed hypotension, tachycardia, and pulsus paradoxus. Imaging demonstrated a large right pleural effusion, a small anterior pericardial effusion, and echocardiographic tamponade. After bedside thoracentesis, echocardiographic findings of tamponade resolved, and the patient’s symptoms improved. In this patient, a large pleural effusion caused tamponade physiology rather than a pericardial effusion. Increased intrathoracic pressure can impair cardiac filling and result in tamponade physiology, and thoracentesis can resolve tamponade physiology even without pericardiocentesis. This case highlights the importance of recognizing extracardiac factors that may cause cardiac tamponade and warrant a tailored diagnostic and therapeutic approach.
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Zaidi et al. (2026) studied this question. Thoracentesis resolved echocardiographic cardiac tamponade caused by large pleural effusion without pericardiocentesis in a post-mitral valve replacement patient.
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