PM1033: Clinical Characterization of Hemodynamically Significant Pericardial Effusion in Children Who Underwent Invasive Pericardial Drainage: Can We Predict the Outcomes?

Background: Massive pericardial effusion (PE) often occurs silently with sudden hemodynamic derangement. Pathogenesis of PE is complex and poorly understood in children. Both primary disease and medical intervention can contribute to its pathogenesis.

Methods: A cross-sectional, retrospective study was conducted in children who underwent invasive pericardial drainage for massive PE. Post cardiac surgery patients within 30 days were excluded. Demographic data, causative etiology, presenting symptoms, involved organ systems, echocardiographic findings, and outcomes were studied. Medical complexity was defined as pre-existing chronic medical conditions requiring specific treatment. Outcomes included PE volume, pericardial drainage duration, and recurrence of PE that required additional intervention.

Results: A total of 44 patients (23 males, 7.9 ± 6.3 years old [1 day to 20 years]) were reviewed. Contributing causes, primary disease-related and treatment-related, are listed in Table 1. Thirty-two patients (73%) had medical complexity: status post major non-cardiac surgery (including transplant: 12), chronic organ failure (3), dialysis (3), extracorporeal membrane oxygenation (2), chronic complications due to prematurity (2), gastrostomy tube dependence (2), mechanical ventilation (2), ventriculo-peritoneal shunt (1). All 11 patients with malignancy were considered medically complex. Eighteen patients (41%) had treatment-related contributing factors including 12 hematopoietic stem cell (9) or liver (3) transplant recipients. Clinical presentations including systemic venous congestion (gastrointestinal symptoms or edema), pulmonary venous congestion (respiratory symptoms), and decreased cardiac output (dizziness, syncope, or lethargy) were reviewed in reference to age differences. Thirty three patients exhibited symptoms and 4 patients were asymptomatic (Table 2). The drained PE volume (ml/m2) was comparable among all age groups. There was a significant relationship between medical complexity and drainage duration (p = 0.05), but no significant relationship between medical complexity and PE volume or recurrence. There were no sex differences in relation to outcomes. There was no correlation between age and effusion volume or recurrence, but there was a negative correlation between age and drainage duration by regression analysis (r = -0.31; p = 0.05). A presence of right atrial (RA) collapse had no correlation with effusion volume, drain duration, or recurrence. Among all age groups, majority of patients presented with pulmonary venous congestion (65%), and 41% presented with symptoms from more than 1 symptom category.

Conclusion: Majority of massive PE occurred in medically complex patients. Both medical complexity and younger age were correlated with longer pericardial drainage duration. Echocardiographic finding of RA collapse was not correlated with any outcomes. Post-transplant status and iatrogenic causes were frequently involved in PE development, suggesting more advanced medical treatment in medically complex children may increase the incidence of massive PE.