Development of left ventricular apical akinesis and thrombus during pericardiocentesis for pericardial tamponade

Although pericardiocentesis is a more practical and comfortable alternative to surgical drainage in patients with pericardial tamponade, it may sometimes be associated with transient ventricular dysfunction due to rapid drainage of the fluid. We presented a 42-year-old female patient who developed left ventricular systolic dysfunction and thrombus concomitant with segmental wall motion disorder in the left ventricle during pericardiocentesis for the treatment of massive pericardial effusion and cardiac tamponade. The patient developed acute dyspnea and tachycardia on the second day of pericardiocentesis with a drainage of 500 ml per day. Left ventricular ejection fraction decreased to 20%, and there was akinesis in the left ventricular apex, and severe hypokinesis in the septum. The amount of daily drainage was decreased to 250 ml. Echocardiography performed on the fifth day showed an image, 1x1 cm in size, compatible with an apically located thrombus and unfractionated heparin infusion was initiated. Coronary angiography showed normal coronary arteries. At the end of the first week, the drainage decreased below 50 ml/day. Ejection fraction returned to normal at the end of 10 days and the thrombus diminished and disappeared. Analysis of the pericardial fluid showed tuberculous pericarditis and antituberculous treatment was instituted.