Why the study?
Does drainage of pericardial effusions (pericardiocentesis or pericardial window) affect mortality in patients with pulmonary arterial hypertension?
Does drainage of pericardial effusions (pericardiocentesis or pericardial window) affect mortality in patients with pulmonary arterial hypertension?
Drainage of pericardial effusions in patients with pulmonary arterial hypertension is associated with high periprocedural mortality, suggesting conservative management should be considered when possible.
Answers are grounded in this paper and cite their sources.
High periprocedural mortality after drainage in PAH cases warrants caution; leaves open whether conservative management improves outcomes.
OBJECTIVES: Pulmonary arterial hypertension (PAH) in its advanced stages is complicated by right heart failure and often pericardial effusion. The optimal treatment of large or hemodynamically significant pericardial effusions in this group has not been defined. METHODS: All patients followed at the Johns Hopkins Hospital for PAH during a 1-year period that underwent pericardiocentesis or pericardial window placement were identified. Charts were analyzed for patient characteristics, echocardiographic data, and type/outcome of procedure. RESULTS: Six patients were identified; five underwent therapeutic drainage. Pericardiocentesis was performed in four cases; two had surgical pericardial windows. Two patients died after pericardiocentesis and one patient died after surgery. All patients died within 13 hours of the procedure. CONCLUSION: We found a high mortality related to pericardial fluid drainage in patients with PAH. The pathophysiologic explanation for these deaths remains unclear, but clinicians should consider conservative management in this situation if possible.
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Hemnes et al. (2008) studied this question.
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