Operation for diagnosis and treatment of pericardial effusions

An experience with 32 consecutive patients with pericardial effusions is reviewed and presented. Malignant effusions: Twenty patients had underlying malignancy. Five had no symptoms, nine had ambiguous symptoms, and six had pericardial tamponade. Initial treatment in eight was pericardiocentesis, which provided diagnosis and treatment in one but was clinically unsuccessful in seven and caused right ventricular puncture in one. Subxiphoid pericardial window in 19 patients showed malignant involvement in six but documented a nonmalignant effusion in 13. There were no operative complications, and no effusions have recurred with long-term follow-up. Only two patients with true malignant effusions had significant long-term survival as compared with 11 of 13 with benign effusions. Uremic effusions: Six patients with renal failure required intervention, three for hemodynamic compromise and one for possible infection. Diagnostic pericardiocentesis documented a sterile effusion in one patient. Five patients had subxiphoid pericardial window without recurrence of effusion. One patient required reexploration for rectus muscle bleeding. Other effusions: All six patients had hemodynamic compromise. Pericardiocentesis was successful in three of four patients but effected resolution in none. Subxiphoid pericardial window was performed in all. The effusion recurred in a patient with periarteritis nodosa, and a patient with viral myocarditis developed a left ventricular pseudoaneurysm that required operation.

Subxiphoid pericardial window provides definitive diagnosis and treatment for pericardial effusions of all causes with low morbidity rates whereas pericardiocentesis is safe but usually ineffective/unproductive; many effusions in patients with cancer are not related to malignant pericardial involvement and documentation is important for treatment planning.