Malignant pericardial tamponade

Rinkevich, Diana; Borovik, R.; Bendett, M.; Markiewicz, Walter

doi:10.1002/mpo.2950180406

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…This holds true even in carcinomatous pericardial effusion. The drain may be introduced either surgically through a limited subcostal incision, or percutaneously [3,4,6,8,9,12]. In order to further reduce the incidence of recurrent effusion, many authors have associated drainage with the instillation of drugs aimed at obliterating the pericardial cavity.…”

Section: Discussionmentioning

confidence: 99%

“…However, no randomized study comparing the effect of drainage alone versus drain age plus tetracycline administration has been reported. Thus, some doubt remains as to whether the excellent re sults seen clinically after intrapericardial administration of tetracycline could not be obtained by insertion of a pericardial drain alone [8], The combination of pericardial irritation induced by the presence of a drain and of rubbing of the pericardial leaflets secondary to emptying of the pericardial sac could be a major factor in causing pericar dial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Pericar dial drainage alone has been effective in relieving tam ponade [7,8]. However, effusion tends to recur.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Minocin on the Pericardium

Markiewicz

Ben-Arieh²,

Best³

et al. 1993

Oncology

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The purpose of this study was to evaluate in a dog model whether intrapericardial instillation oftetracycline is superior to the effect of drainage alone in causing pericardial adhesions and cavity obliteration. Twelve mongrel dogs were randomly divided into two experimental groups. All dogs received a pericardial drain through a sterile thoracotomy. Group A dogs (n = 6) received minocycline hydrochloride, 20 mg/kg, group B received normal saline. All dogs were sacrificed 1 month later. Echocardiograms performed 1 week postsurgery were normal in all dogs. Macroscopic evaluation disclosed that all group A dogs had over 25% cavity obliteration whereas group B dogs had no adhesions or had obliteration of less than 25% of the cavity area. Microscopic evaluation showed that group A dogs had severe pericardial fibrosis and thickening with slight focal lymphoplasmocytic infiltration. Myocardial damage was not seen. Our results support the clinical use of injecting tetracycline into the pericardium (in addition to drainage) to cause cavity obliteration in patients with persistent pericardial effusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Effect of Minocin on the Pericardium

Markiewicz

Ben-Arieh²,

Best³

et al. 1993

Oncology

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Image-Guided Drainage of Pericardial Effusions in Oncology Patients

Tam

Ensor

Snyder

et al. 2009

Cardiovasc Intervent Radiol

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The purpose of this study was to report our clinical experience with image-guided drainage of pericardial effusions in oncology patients. IRB approval was obtained for this retrospective, HIPAA-compliant study. From November 2002 to January 2008, 40 patients underwent 43 image-guided drainages of pericardial effusions. The medical records were reviewed to analyze the technical aspects of the procedures, complications, and clinical outcomes. Thirty-three pericardial drains were placed and 10 pericardiocenteses were performed. The technical success rate was 100%. Thirty-three procedures were performed under computed tomographic (CT) guidance, five under ultrasound (US) guidance, and five using both CT and US guidance. There were no technical, procedure-related complications. Delayed postprocedure complications and arrhythmias occurred in 11 cases, for an overall complication rate of 25.6%. All complications occurred in patients who had undergone drain placement. Nine patients developed new or worsening arrhythmias and six of these patients required transfer to a higher level of care or the initiation of pharmacological management. In 58.6% of drain placements, including 4 of 11 patients who developed complications, the catheter could have been removed earlier. The median overall survival was 6.47 months (95% CI: 2.37, 12.7). In conclusion, image-guided pericardial drain placement is safe and feasible. Due to the frequency of delayed postprocedure arrhythmias, follow-up monitoring in a telemetry unit is recommended. Prompt catheter removal after drainage may reduce the incidence of delayed post-catheter-insertion arrhythmias.

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