High-Volume Hemofiltration as Adjuvant Therapy for Refractory Shock after Pericardiocentesis

Authors

  • Romuald Lango
  • Maciej M. Kowalik
  • Piotr Siondalski
  • Jan Rogowski
  • Alicja Dabrowska-Kugacka

DOI:

https://doi.org/10.1532/HSF98.20111028

Abstract

Background: Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.

Case Report: We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.

Discussion: The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.

Conclusions: We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.

References

Bellomo R, Honore P, Matson J, Ronco C, Winchester J. 2005. Extracorporeal blood treatment (EBT) methods in SIRS/sepsis. Int J Artif Organs 28:450-8.nBernal JM, Pradhan J, Li T, Tchokonte R, Afonso L. 2007. Acute pulmonary edema following pericardiocentesis for cardiac tamponade. Can J Cardiol 23:1155-6.nCornejo R, Downey P, Castro R 2006. High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock. Intensive Care Med 32:713-22.nDowney RJ, Bessler M, Weissman C. 1991. Acute pulmonary edema following pericardiocentesis for chronic cardiac tamponade secondary to trauma. Crit Care Med 19:1323-5.nKaramichalis JM, Gursky A, Valaulikar G, Pate JW, Weiman DS. 2009. Acute pulmonary edema after pericardial drainage for cardiac tamponade. Ann Thorac Surg 88:675-7.nLango R, Kowalik MM, Klajbor K, Pawlaczyk R, Musia?wi tkiewicz V, Rogowski J. 2009. High-volume hemofiltration as rescue therapy for refractory shock after inadvertent rapid aprotinin administration. J Cardiothorac Vasc Anesth 23:526-8.nLigero C, Leta R, Bayes-Genis A. 2006. Transient biventricular dysfunction following pericardiocentesis. Eur J Heart Fail 8:102-4.nMagnotti LJ, Upperman JS, Xu DZ, Lu Q, Deith EA. 1998. Gut-derived mesenteric lymph but not portal blood increases endothelial cell permeability and promotes lung injury after hemorrhagic shock. Ann Surg 228:518-27.nShenoy MM, Dhar S, Gittin R, Sinha AK, Sabado M. 1984. Pulmonary edema following pericardiectomy for cardiac tamponade. Chest 86:647-8.nWolfe MW, Edelman ER. 1993. Transient systolic dysfunction after relief of cardiac tamponade. Ann Intern Med 119:42-4.n

Published

2011-10-13

How to Cite

Lango, R., Kowalik, M. M., Siondalski, P., Rogowski, J., & Dabrowska-Kugacka, A. (2011). High-Volume Hemofiltration as Adjuvant Therapy for Refractory Shock after Pericardiocentesis. The Heart Surgery Forum, 14(5), E313-E316. https://doi.org/10.1532/HSF98.20111028

Issue

Section

Article