Pericardial effusion after pediatric cardiac surgeries: a single center observation

Abstract

Background:Development of fibrinous pericarditis after pericardiotomy is a well-recognized reaction. Within a few post-operative days, the inflammated surface of pericardium begins to fuse to the overlying sternum.Objectives:Our aim was to assess the prevalence, risk factors, time course and therapy response of pericardial effusion (PE) after cardiac surgeries in children.Patients and Methods:PE occurrence was assessed prospectively in 486 children who underwent cardiac surgery for congenital heart diseases by serial echocardiography. Clinical manifestations were observed and response to different therapies was analyzed.Results:The prevalence of PE was about 10% for all cardiac surgeries. Symptoms were exclusively seen in patients who had moderate to large effusions. The mean onset of pericardial effusion was 11 (± 8) days after surgery procedure, with 87 % (42 of 48) of cases being diagnosed on or before day 13 after operation. The prevalence of effusion after Fontan-type procedures and AVSD repair (29 %, 5 of 17 for both) was significantly higher than other types of cardiac surgeries. Aspirin administration was effective in 77 % and prednisone in 90 % of the cases.Conclusions:PE may be developed as late as weeks after cardiac surgeries. PE after palliative cardiac surgeries is not uncommon. Low doses of aspirin and corticosteroids are usually effective for treating this complication.

Risk of Clinically Relevant Pericardial Effusion After Pediatric Cardiac Surgery

“…However, also some contradictions were found, since in this study no effect of gender or diagnosis severity could be identified and higher thoracic drain production, anticoagulation use, or longer intensive care stay did not seem to convey any additional risk [7, 8, 16]. In addition, this study identified cardiopulmonary bypass use and right-sided heart defects as new risk factors for crPE in children.…”

“…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]. …”

Factors Associated with Readmission of Patients with Congenital Heart Disease in a Swiss University Hospital

“…Still, it would be of interest to assess the reasons for a longer LOS and if it is related with a better preparation of the patient and the family. Another explanation is the natural timeline of complications after CHD surgery, namely the fact that pleural [13] and pericardial [14] [15] effusions usually occur within two weeks of surgery. Thus, patients who remain in hospital for 14 days can have their complications treated within the same hospital stay, whereas patients discharged earlier need to be readmitted for the management of their post-operative complication.…”

Bedside Ultrasound in the Diagnosis and Treatment of Children with Respiratory Difficulty Following Cardiac Surgery

“…The incidence of PE was reported 10%–13.6% for all cardiac surgeries in the recent studies. [ 36 37 ] PE occurs most commonly after corrective cardiac surgeries but may be observed in all types of surgeries involving the pericardial sac. [ 38 39 ] It contributes to postoperative morbidity and mortality, hence to be a risk for hemodynamic compromise.…”