Related Experiment Videos
Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences
M Pepi1, M Muratori, P Barbier
1Istituto di Cardiologia, Università degli Studi, Fondazione I Monzino IRCCS, Milan, Italy.
Insights
Pericardial effusion is common after cardiac surgery, with size and location varying by procedure. Cardiac tamponade is rare but more frequent after valve replacement surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Pericardial effusion is a potential complication following cardiac surgery.
- Understanding its incidence, characteristics, and hemodynamic impact is crucial for patient management.
Purpose of the Study:
- To evaluate the incidence, characteristics, and hemodynamic consequences of pericardial effusion after cardiac surgery.
- To assess the utility of echocardiography and Doppler in managing these effusions.
Main Methods:
- Prospective evaluation of 780 patients undergoing cardiac surgery.
- Clinical, echocardiographic, and Doppler assessments before and 8 days post-surgery.
- Follow-up for patients with moderate to large effusions.
Main Results:
- Pericardial effusion detected in 64% of patients, more common after coronary artery bypass grafting.
- Small effusions (68.4%) typically resolved; moderate effusions (29.8%) often decreased.
- Cardiac tamponade occurred in 1.9% of patients, significantly more often after valve replacement.
Conclusions:
- Pericardial effusion is a frequent post-cardiac surgery finding, influenced by surgical type.
- Cardiac tamponade is uncommon but a serious complication, particularly in valve replacement patients.
- Echo-Doppler imaging effectively identifies pericardial effusions and aids in detecting impending cardiac tamponade.
Objective:
To evaluate the incidence, characteristics, and haemodynamic consequences of pericardial effusion after cardiac surgery.
Design:
Clinical, echocardiographic, and Doppler evaluations before and 8 days after cardiac surgery; with echocardiographic and Doppler follow up of patients with moderate or large pericardial effusion after operation.
Setting:
Patients undergoing cardiac surgery at a tertiary centre.
Patients:
803 consecutive patients who had coronary artery bypass grafting (430), valve replacement (330), and other types of surgery (43). 23 were excluded because of early reoperation.
Main Outcome Measures:
Size and site of pericardial effusion evaluated by cross sectional echocardiography and signs of cardiac tamponade detected by ultrasound (right atrial and ventricular diastolic collapse, left ventricular diastolic collapse, distension of the inferior vena cava), and Doppler echocardiography (inspiratory decrease of aortic and mitral flow velocities).
Results:
Pericardial effusion was detected in 498 (64%) of 780 patients and was more often associated with coronary artery bypass grafting than with valve replacement or other types of surgery; it was small in 68.4%, moderate in 29.8%, and large in 1.6%. Loculated effusions (57.8%) were more frequent than diffuse ones (42.2%). The size and site of effusion were related to the type of surgery. None of the small pericardial effusions increased in size; the amount of fluid decreased within a month in most patients with moderate effusion and in a few (7 patients) developed into a large effusion and cardiac tamponade. 15 individuals (1.9%) had cardiac tamponade; this event was significantly more common after valve replacement (12 patients) than after coronary artery bypass grafting (2 patients) or other types of surgery (1 patient after pulmonary embolectomy). In patients with cardiac tamponade aortic and mitral flow velocities invariably decreased during inspiration; the echocardiographic signs were less reliable.
Conclusions:
Pericardial effusion after cardiac surgery is common and its size and site are related to the type of surgery. Cardiac tamponade is rare and is more common in patients receiving oral anticoagulants. Echo-Doppler imaging is useful for the evaluation of pericardial fluid accumulations after cardiac surgery. It can identify effusions that herald cardiac tamponade.