Subxiphoid window drainage of pericardial effusion - study of 35 cases

Abstract

Pericardial effusion defines the presence of an abnormal amount and/or character of fluid in the pericardial space. It can be acute or chronic and caused by a variety of local and systemic disorders, or it may be idiopathic. Pericardial effusion can be relieved by medical treatment, pericardiocentesis through a needle with or without echocardiographic guidance, or by surgical procedures, such as subxiphoid pericardial tube drainage, by creating a pericardial window through a left anterior thoracotomy, or by video assisted thoracoscopic surgery (VATS) Subxiphoid pericardial window drainages were done on 35 patients with symptomatic pericardial effusion in the Department of cardiac surgery, BSMMU, from February, 1995 through July, 2009, and were all included in this retrospective observational study. The inclusion criteria were an established diagnosis of pericardial effusion confirmed by history, physical findings and transthoracic echocardiography, hemodynamic alteration as evidenced by hypotension( systolic blood pressure < 90 mm of Hg), shortness of breath, echocardiographic finding of > 10 mm echo free space with/ without compression of heart, recurrence after pericardiocentesis, haemorrhagic or thick pericardial effusion and malignant pericardial effusion. The exclusion criteria were loculated or post surgical pericardial effusion, effusive constrictive pericarditis or where formal thoracotomy was applied for drainage of effusion. Patients were followed up at one month and three months following the drainage procedure.The age range was from 13 years to 70 years (Mean 47.86 ± SD 15.20 years), 19 (54.28%) were male, 16(45.72%) were female. The symptomatology varied but cardiac and respiratory decompression overwhelmed other symptoms. In this study tuberculosis is the most common cause of pericardial effusion, idiopathic and malignancies are other important causes. Subxiphoid window drainage is an effective process in relieving pericardial effusion and the reaccumulation rate is low.

Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

“…Our finding is in keeping with findings of Agner and Gallis, who observed that tuberculosis and malignant effusion were more likely to cause large pericardial effusion, effusion causing haemodynamic compromise compared to those secondary to idiopathic pericarditis [ 11 ]. Other studies done in regions with high endemicity for TB also revealed TB as the most common cause of pericardial effusion [ 12 , 13 ]. All our patients suspected to have TB pericardial effusion received an initial 4-drug therapy for 2 months (isoniazid, rifampicin, pyrazinamide, and ethambutol) followed by isoniazid and rifampicin for the remaining 4 months.…”

“…Orthopnea was particularly observed in patients who presented with cardiac tamponade. Other studies have reported dyspnoea as the most common symptoms [ 11 , 12 ]. Many patients (43.8%) presented with history and echocardiographic features in keeping with cardiac tamponade because generally in the developing world most of our patients present late.…”