Abstract
BACKGROUND: Pericardial decompression syndrome (PDS) is a rare but life-threatening complication that causes hemodynamic collapse after the drainage of pericardial effusion. CASE SUMMARY: A 10-year-old boy with persistent cough and syncope presented at our hospital. An echocardiogram revealed a large pericardial effusion. Immediately after surgical pericardiostomy, the patient became slightly hypotensive. Massive tricuspid regurgitation developed, the right ventricle (RV) became enlarged, and RV dysfunction emerged. We initiated olprinone and diuretics. Hypotension recovered within the following 24 hours, and the size and function of the RV normalized within 12 days. DISCUSSION: The RV was unable to adapt functionally and structurally to a rapid increase in preload after drainage. The detailed changes in echocardiographic findings in the present case provide novel information. TAKE-HOME MESSAGE: Inasmuch as PDS can also develop in childhood, clinicians need to consider this potentially fatal complication when removing pericardial effusion even in pediatric patients.