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Pericardial effusion after open heart surgery for congenital heart disease
E W Y Cheung1, S A Ho, K K Y Tang
1Division of Paediatric Cardiology, Grantham Hospital, The University of Hong Kong, Hong Kong, People's Republic of China. xfcheung@hkucc.hku.hk
Insights
Pericardial effusion is common after congenital heart defect surgery, affecting 23% of patients. Female sex and warfarin use are key risk factors, indicating a need for monitoring in high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Echocardiography
Background:
- Pericardial effusion is a potential complication following open heart surgery.
- Congenital heart diseases require complex surgical interventions, increasing the risk of postoperative complications.
Purpose of the Study:
- To investigate the incidence and temporal pattern of pericardial effusion after open heart surgery for congenital heart disease.
- To identify significant risk factors associated with the development of pericardial effusion.
Main Methods:
- A prospective study involving 336 patients undergoing open heart surgery for congenital heart disease.
- Serial echocardiography was performed on postoperative days 5, 7, 14, 21, and 28 to assess for pericardial effusion.
- Risk factors were analyzed using univariate and multivariate logistic regression.
Main Results:
- Pericardial effusion was diagnosed in 23% of patients, with 56% having moderate to large effusions and 23% experiencing symptoms.
- The mean onset of effusion was 11 days post-surgery, with most cases detected by day 28.
- Fontan-type procedures showed a significantly higher prevalence (60%) of effusion.
- Female sex and warfarin treatment were identified as significant risk factors for developing pericardial effusion.
Conclusions:
- Pericardial effusion is a frequent complication after open heart surgery for congenital heart disease.
- Serial echocardiographic monitoring is recommended for high-risk patients, including those on warfarin or exhibiting symptoms of postpericardiotomy syndrome.
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 (beta = 1.73, p = 0.009) and female sex (beta 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.