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

Abstract

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

Subxiphoid Tube Pericardiostomy in the Management of Pericardial Effusion: Our Experience

“…In our series, there is male preponderance which is what obtains in most studies without any statistically significant difference [7,[13][14]. Dyspnea was the predominant symptom in our patients and majority of our patients presented in tamponade which has been reported as the commonest mode of presentation in patients with massive pericardial effusion or posttraumatic acute haemopericardium [1,4,[15][16]. This is always the case in our environment because majority of patients will only present when symptoms are unbearable.…”

“…It serves as a lubricant between the two layers thereby preventing friction. Pathologies that cause inflammation of the pericardium can lead to exudative pericardial effusion while on the alternative decreased reabsorption due to general increase in systemic venous pressure as a result of congestive cardiac failure or pulmonary hypertension may lead to accumulation of transudative pericardial fluid [1][2][3][4]. There are various classifications of pericardial effusion.…”