Comparison of Effectiveness and Safety of Operations on the Pericardium

Palatianos, George M.; Thurer, Richard J.; Kaiser, Gerard A.

doi:10.1378/chest.88.1.30

Cited by 35 publications

(20 citation statements)

References 13 publications

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“…All 4 patients treated with drainage without intrapericardial instillation remained free of fluid accumulation, confirming reports that drainage alone is frequently effective in treating malignant pericardial effusion [6,10,16,24,25]. Recent studies suggest that drainage associated with intrapericardial instillation of tetracycline might be superior to drainage along [11,21].…”

Section: Discussionsupporting

confidence: 74%

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Malignant pericardial tamponade

Rinkevich¹,

Borovik²,

Bendett³

et al. 1990

Med. Pediatr. Oncol.

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We studied the clinical course and management of 27 patients with malignant pericardial tamponade seen in a single Medical Center over a 10 year period. Patients treated with repeat pericardial tap as their only mode of therapy had a high rate of recurrent tamponade (6 of 13 subjects) whereas most patients treated with drainage (either surgical or percutaneous) had sustained control of their pericardial effusion (achieved in 10/13 subjects). Intra-pericardial instillation of tetracycline or cyclophosphamide did not clearly improve the good results obtained with drainage alone. Extensive pericardiectomy was required in 2 patients only. Irrespective of the mode of therapy, survival was poor in patients with carcinoma of lung (N = 10) with a median survival of 30 days only vs. 135 days for patients with breast carcinoma (N = 10). Patients with malignant pericardial tamponade are best treated with immediate drainage. Percutaneous and sub-xiphoid surgical drainage are equally effective. Despite invasion of the pericardium by carcinoma, patients with a good oncologic prognosis may enjoy an appreciable survival with adequate quality of life following relief of tamponade.

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Section: Discussionsupporting

confidence: 74%

“…In recent years, surgical drainage performed through a limited sub-xyphoid incision has emerged as an acceptable alternative to the more traditional pericardiocentesis [6,10,16,24,25].…”

Section: Discussionmentioning

confidence: 99%

Malignant pericardial tamponade

Rinkevich¹,

Borovik²,

Bendett³

et al. 1990

Med. Pediatr. Oncol.

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“…A surgically created pericardial window provides good immediate and long-term results for pericardial effusions [7,8]. In reports of large series of malignant pericardial effusions treated surgically, morbidity and late recurrence of symptoms are not uncommon [9,10]. In patients with inflammatory pericarditis and in those with malignant pericardial effusion the surgical window frequent seals off and in some cases total pericardiectomy could be required.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade

Palacios

Tuzcu

Ziskind

et al. 1991

Cathet. Cardiovasc. Diagn.

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We performed percutaneous balloon pericardial window (PBPW) in 8 patients (age 40 to 70 yrs; 4 men, 4 women) with malignant pericardial effusion and tamponade. Pericardial window was indicated because they continued to drain greater than 100 ml/day of pericardial fluid through the pigtail catheter for greater than or equal to 3 days. A 0.038 inch guidewire was advanced through the pigtail catheter into the pericardial space and then the catheter was removed. A 20 mm diameter, 3 cm long balloon dilating catheter was advanced to straddle the parietal pericardium. Manual inflations were performed until the waist produced by the pericardium disappeared. All patients tolerated the procedure well with minimal discomfort and with no complications. A left or bilateral pleural effusion occurred in all patients after PBPW. No patient developed recurrent pericardial tamponade at a mean follow-up of 6 +/- 2 months. Thus, PBPW is a useful and safe technique to avoid surgery in patients with malignant pericardial effusion and tamponade.

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“…The intrapericardial instillation of nonabsorbable steroids has been used with good results in patients presenting with uremic pericardial effusion or tamponade. • Reaccumulation of fluid with recurrence of cardiac tamponade has been considered as an indication for a surgical intervention [21][22][23][24][25][26][27][28][29][30][31]; however, morbidity and late recurrence of symptoms are not uncommon with this technique [22][23][24].…”

Section: Prevention Of Fluid Reaccumulationmentioning

confidence: 99%

“…Some surgeons have recommended the subxiphoid approach as primary therapy for malignant pericardial tamponade based on its high initial success rate and acceptable rate of recurrence [22][23][24][25][26][27]. Transthoracic techniques offer a lower recurrence rate but are associated with higher morbidity [23][24][25][26][27][28][29][30][31].…”

Section: Percutaneous Balloon Pericardial Window Creationmentioning

confidence: 99%

Pericardial effusion and tamponade

Palacios

1999

Curr Treat Options Cardio Med

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Pericardial effusion may occur as a result of a variety of clinical conditions, including viral, bacterial, or fungal infections and inflammatory, postinflammatory, autoreactive, and neoplastic processes. More common causes of pericardial effusion and tamponade include malignancy, renal failure, viral and bacterial infectious processes, radiation, aortic dissection, and hypothyroidism. It can also occur after trauma or acute myocardial infarction (as in postpericardiotomy syndrome following cardiac or thoracic surgery) or as an idiopathic pericardial effusion. Although pericardial effusion is common in patients with connective tissue disease, cardiac tamponade is rare. Among medical patients, malignant disease is the most common cause of pericardial effusion with tamponade. Table 1 shows the causes of pericardial tamponade. The effusion fluid may be serous, suppurative, hemorrhagic, or serosanguineous. The pericardial fluid can be a transudate (typically occurring in patients with congestive heart failure) or an exudate. The latter type, which contains a high concentration of proteins and fibrin, can occur with any type of pericarditis, severe infections, or malignancy. Once the diagnosis of pericardial effusion has been made, it is important to determine whether the effusion is creating significant hemodynamic compromise. Asymptomatic patients without hemodynamic compromise, even with large pericardial effusions, do not need to be treated with pericardiocentesis unless there is a need for fluid analysis for diagnostic purposes (eg, in acute bacterial pericarditis, tuberculosis, and neoplasias). The diagnosis of pericardial effusion/tamponade relies on a strong clinical suspicion and is confirmed by echocardiography or other pericardial imaging modalities. Alternatively, when the diagnosis of cardiac tamponade is made, there is a need for emergency drainage of pericardial fluid by pericardiocentesis or surgery to relieve the hemodynamic compromise. Following pericardiocentesis, it is necessary to prevent recurrence of tamponade. Intrapericardial injection of sclerosing agents, surgical pericardiotomy, and percutaneous balloon pericardial window creation are techniques used to prevent reaccumulation of pericardial fluid and recurrence of cardiac tamponade.

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Comparison of Effectiveness and Safety of Operations on the Pericardium

Cited by 35 publications

References 13 publications

Malignant pericardial tamponade

Malignant pericardial tamponade

Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade

Pericardial effusion and tamponade

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