Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

Abstract

Background: As a result of the increased life expectancy of cancer patients due to developing effective treatments applied, the incidence of secondary patterns such as malignant pericardial effusion has increased. Therefore, pericardial effusions leading to cardiac tamponade have been becoming an increasingly common emergency in medical practice. Although positive results are obtained with echocardiography-guided pericardiocentesis or percutaneous catheter drainage in pericardial effusions causing tamponade, the effusion may recur in some malignant cases. In the management of such patients, it is desirable to provide permanent drainage by opening a pericardial window instead of performing frequent pericardiocentesis. Case Presentation: A 62-year-old male patient with tamponade was admitted to our hospital. The clinical picture was corrected by pericardiocentesis accompanied by echocardiography. However, due to rapid fluid accumulation that required pericardiocentesis every other day, he was referred to the cardiovascular surgery department for surgical drainage. The patient clinically improved after the subxiphoid pericardial window was created. However, when symptoms of tamponade developed again 24 hours after the chest tube was removed, a pericardioperitoneal window was opened with a subxiphoidal approach. There were no recurrences of effusion for three months until the patient died of malignancy. Conclusion: In patients who have undergone pleurodesis or who are not suitable for general anesthesia due to their hemodynamic conditions, the best surgical procedure to prevent recurrent effusions causing tamponade is to create a pericardioperitoneal window under local anesthesia.