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Treatment of exudative fibrinous pericarditis with intrapericardial urokinase
W B Winkler1, R Karnik, J Slany
1Department of Internal Medicine II, Krankenanstalt Rudolfstiftung, Wien, Austria.
Insights
Transcatheter intrapericardial urokinase effectively dissolved fibrin layers in purulent pericarditis patients unresponsive to pericardiocentesis, preventing constrictive pericarditis. This minimally invasive treatment showed no systemic coagulation issues or lysis-related complications.
Area of Science:
- Cardiology
- Interventional Radiology
- Medical Procedures
Background:
- Purulent pericarditis can lead to chronic constrictive pericarditis if not adequately drained.
- Pericardiocentesis is a standard procedure for pericardial effusion but may be insufficient for complete drainage in purulent cases.
- The formation of dense fibrin layers complicates drainage and increases the risk of constrictive pericarditis.
Observation:
- Three male patients with purulent pericarditis had incomplete drainage via pericardiocentesis.
- These patients were treated with transcatheter intrapericardial urokinase.
- The goal was to prevent the development of chronic constrictive pericarditis.
Findings:
- Echocardiography demonstrated the disappearance of intrapericardial fibrin layers in two patients.
- In the third patient, intrapericardial fibrin layers were reduced by more than half.
- No adverse effects on systemic coagulation indices were observed.
- No complications related to intrapericardial urokinase lysis were reported.
Implications:
- Transcatheter intrapericardial urokinase is a viable and safe therapeutic option for managing purulent pericarditis with significant fibrin burden.
- This approach may prevent the progression to constrictive pericarditis, avoiding more invasive surgical interventions.
- Further research with larger cohorts is warranted to confirm these findings and establish optimal treatment protocols.
Abstract:
Three male patients with purulent pericarditis, in whom complete drainage could not be obtained by pericardiocentesis, were treated with transcatheter intrapericardial urokinase to prevent the development of chronic constrictive pericarditis. As shown by echocardiography, the intrapericardial fibrin layers disappeared in two cases and were reduced by more than half in the third. Effects on systemic coagulation indices and complications related to intrapericardial lysis were not observed.