Pericardial effusion after open heart surgery for congenital heart disease

Abstract

Objectives: To determine the prevalence and time course of pericardial effusion after open heart surgery for congenital heart diseases and to identify predisposing risk factors. Design and patients: Prospective assessment of development of pericardial effusion in 336 patients (163 males) undergoing open heart surgery for congenital heart disease by serial echocardiography on days 5, 7, 14, 21, and 28 postoperatively. Setting: Tertiary paediatric cardiac centre. Results: The prevalence of pericardial effusion was 23% (77 of 336). Of the 77 patients who developed effusion, 43 (56%) had moderate to large effusions and 18 (23%) were symptomatic. Patients who had a large amount of effusion were more likely to be symptomatic than those with only a small to moderate amount (47.4% v 15.5%, p = 0.01). The mean (SD) onset of pericardial effusion was 11 (7) days after surgery, with 97% (75 of 77) of cases being diagnosed on or before day 28 after surgery. The prevalence of effusion after Fontan-type procedures (60%, 6 of 10) was significantly higher than that after other types of cardiac surgery: repair of left to right shunts (22.1%, 43 of 195), repair of lesions with right ventricular outflow tract obstruction (22.6%, 19 of 84), arterial switch operation (6.7%, 1 of 15), and miscellaneous procedures (25%, 8 of 32) (p = 0.037). Univariate analyses showed that female patients (p = 0.009) and those receiving warfarin (p = 0.002) had increased risk of postoperative pericardial effusion. A greater pericardial drain output in the first four hours after surgery also tended to be significant (p = 0.056). Multivariate logistic regression similarly identified warfarin treatment (β = 1.73, p = 0.009) and female sex (β for male = −0.63, p = 0.037) as significant determinants. Conclusions: Pericardial effusion occurs commonly after open heart surgery for congenital heart disease. Serial echocardiographic monitoring up to 28 days postoperatively is indicated in selected high risk patients such as those with symptoms of postpericardiotomy syndrome and those given warfarin. P ericardial effusion occurs commonly after open heart surgery and contributes to postoperative morbidity and mortality.1-5 Nonetheless, data on its prevalence and time course after surgery for congenital heart disease are limited.6 7 Furthermore, risk factors that predispose to its development in children and teenagers with congenital heart disease after undergoing open heart surgery remain unknown. In this study, we sought to determine the prevalence and time course of pericardial effusion after different types of open heart surgery for congenital heart disease and, in light of the findings, to identify significant predisposing risk factors. PATIENTS AND METHODSA total of 359 children and teenagers who underwent open heart surgery for congenital heart disease between 1996 and 2001 were recruited. Serial two dimensional echocardiography was performed on days 5, 7, 14, 21, and 28 postoperatively using a Hewlett-Packard ultrasound machine (Sonos 1500 or 5500) to asses...

Incidence and factors associated with pericardial effusion after cardiac valve surgery

“…Patients with moderate-to-severe PE presented higher rate of postoperative atrial fibrillation than absent or small PE patients, similarly to the results described by Ikäheimo et al 8 Arrhythmia can be a marker of higher risk of adverse outcomes in these patients 15,16 which may have mediated a higher incidence of clinical endpoints regardless the presence of PE.…”

“…The high variability of the reported PE incidence after cardiac surgery is related to the different definitions for this condition 3,7,8 . Our study used only echocardiographic parameters to define PE, while others used clinical presentation and echocardiographic data 7 ; however, our incidence of PE is in the lower range of published incidence rates.…”

Risk of Clinically Relevant Pericardial Effusion After Pediatric Cardiac Surgery

“…Furthermore, higher pericardial drain production postoperatively and the use of anticoagulation were identified as a risk factor for PE after pediatric cardiac surgery [7, 8]. …”

High-vacuum drains rival conventional underwater-seal drains after pediatric heart surgery

“…Small and usually insignificant pleural and pericardial effusions develop in over 50% of patients undergoing cardiac surgery [7][8][9]11,12]. Near complete evacuation of postoperative mediastinal fluid and/or air is imperative in the pediatric population because of the smaller volumes required for hemodynamic compromise.…”