Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients

Abstract

Objective: To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions. Methods: 368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient. Results: The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

“…Acid fast bacilli stains on PE sediment are usually negative and culture sensitivity is no greater than 50% 3,6,14 . Due to the difficulty of establishing the diagnosis of TP using clinical, radiological, cytological or even microbiologic evaluation, attempts to correlate TP diagnosis with other markers have been pursued 5 .…”

Effectiveness of Subxiphoid Percutaneous Catheter Drainage in Management of Pericardial Effusions

“…6 According to Becit et al the most common cause was renal failure because their hospital has a big dialysis centre. 11 However, our hospital accepts patients with renal failure, as it has dialysis centre, the most common cause was malignancy among our patients (43.6%). Among malignancy patients, carcinomas of the lung and breast were the most common underlying malignancies.…”

“…This result is expected and consistent with previous series. 11 Pericardial tamponade is decompensate phase of cardiac compression caused by effusion accumulation and the increased intrapericardial pressure. Previous studies reported tamponade in 44% of patients.…”

The efficacy of VATS, subxiphoid and minithoracotomy pericardial window for surgical management of symptomatic pericardial effusions

“…Becit ve ark. 368 hastada uyguladıkla-rı subksifoid perikardiyal yaklaşımda nüks oranını işlemden bir ay sonra %10 olarak bildirmiştir [19]. Duke üniversitesinde yapılan prospektif bir çalış- mada değişik nedenlerle subksifoid perikardiyal pencere açılan hastaların %16'sında bir yıl içinde nüks oluştuğu rapor edildi [18].…”