Paediatric cardiac tamponade requiring pericardiocentesis: aetiology and age distribution of 252 patients in a tertiary single-centre cohort.

OBJECTIVE

Cardiac tamponade is a rare but life-threatening condition in children, typically requiring urgent percutaneous pericardiocentesis. Despite its clinical importance, comprehensive data on paediatric cardiac tamponade are limited.

METHODS

We retrospectively reviewed 251 paediatric patients (0-18 years) with cardiac tamponade who underwent emergency percutaneous pericardiocentesis to evaluate the aetiological spectrum, age distribution, and associated clinical factors between November 2003 and May 2025. Diagnosis was based on echocardiographic criteria indicating haemodynamic compromise. Patients were categorised by age group, underlying aetiology, and recent history of cardiac intervention.

RESULTS

Structural heart diseases were the leading cause of cardiac tamponade (51.6%), particularly in neonates and infants. Pericardiocentesis was most frequently performed in children aged 6-12 years (28.2%). Cardiomyopathies were more prevalent in older age groups. Infectious causes were the second most common aetiology (11.5%). Cardiac Tamponade occurred more frequently following cardiac surgery (12.3%) than after catheter-based interventions. Iatrogenic tamponade was identified in six patients, most commonly during high-risk transcatheter procedures. Genetic syndromes were present in 30 patients, with Down syndrome being the most common.

CONCLUSIONS

To the best of our knowledge, this study represents the largest single-centre cohort of paediatric cardiac tamponade requiring pericardiocentesis. Cardiac causes, particularly structural heart diseases, represent the most common aetiology across all age groups; therefore, these patients should be promptly evaluated for cardiac tamponade when presenting with relevant symptoms.