Pericardial Decompression Syndrome in a Pediatric Patient

Pericardial decompression syndrome (PDS) is a rare but critical complication of pericardial drainage. It is most associated with pericardial drainage to treat cardiac tamponade but can also occur without preceding tamponade physiology. Pericardial drainage is typically performed to relieve external compression on the heart in order to help restore normal cardiac function. In PDS, patients paradoxically develop hemodynamic instability and pulmonary edema from ventricular dysfunction after drainage of a pericardial effusion. A 4-year-old boy with history of chronic granulomatous disease (CGD) who ultimately underwent haploidentical hematopoietic stem cell transplant (HSCT) required prolonged hospitalization for multiple infections and graft-versus-host disease. His clinical course was complicated by the development of a pericardial effusion for which he underwent pericardiocentesis. Shortly after the procedure, the patient developed worsening hemodynamics and pulmonary edema. Workup revealed new-onset right ventricular failure which was ultimately attributed to PDS. This case highlights PDS as a potential risk associated with pericardiocentesis in pediatric patients. Int J Clin Pediatr. 2024;13(3):105-109 doi: https://doi.org/10.14740/ijcp536