Uremic Pericardial Effusion

Abstract

Pericardial drainage via percutaneous catheter placement and local nonabsorbable steroid instillation was employed as definitive therapy for uremic patients who had intractable pericardial effusions. Twelve patients are reported. Prior daily dialysis, and in one case systemic steroids, were not curative. 11 of 12 cases suffered severe tamponade requiring pericardiocentesis. One patient had an organized pericardial effusion, making pericardiocentesis impossible. He required pericardiectomy with prolonged hospitalization (2 weeks) due to postoperative complications. There were no complications in the 11 patients where catheter drainage and local steroid instillation were employed. No patient had recurrence of his pericardial effusion (followed from 2 weeks to 32 months). Instillation of a relatively nonabsorbable steroid through an indwelling pericardial catheter provides immediate and lasting relief without either the inconvenience or postoperative complications and prolonged hospitalization associated with the surgical procedure of pericardial fenestration. This report offers initial evidence that the percutaneous approach may be a safe and effective alternative to pericardial fenestration in most uremic patients with pericardial effusion.

Recurrent Pericarditis

“…3 Intrapericardial administration of triamcinolone is, by the same token, a good option for recurrent pericarditis and has the added advantage that the steroid is delivered where it contacts the 2 pericardial surfaces. 4 Using a flexible pericardioscope, the medication can be delivered into the pericardial space, even in the absence of effusion.…”

Invited commentary

“…On the other hand, we have evaluated Busselmeir's technique [2] of intrapericardial instillation of poorly absorbable steroids in approximately 20 patients who have not responded to aggressive hemodialysis and who have had an unresponsive effusion. The results have been excellent, with all patients responding within 72 to 96 hours.…”