W. Figueroa et al., SUBXIPHOID PERICARDIAL WINDOW FOR PERICARDIAL-EFFUSION IN END-STAGE RENAL-DISEASE, American journal of kidney diseases, 27(5), 1996, pp. 664-667
Fifty-seven patients with end-stage renal disease who were on maintena
nce dialysis underwent pericardial fluid drainage surgically between J
anuary 1980 and December 1991. All patients had echocardiographically
proven pericardial effusion of more than 300 to 500 mL. Seven patients
had pericardiectomy by left thoracotomy under general anesthesia in t
he first 2 years. Subsequently, 50 patients underwent a subxiphoid per
icardial window by a left subcostal incision, A pericardial drainage t
ube was inserted at surgery and removed after 4 to 5 days, All but fiv
e patients undergoing subxiphoid pericardial window surgery received l
ocal anesthesia, The xiphoid process was not resected during surgery a
nd steroids were not instilled in the pericardial cavity, There were m
inimal complications, no surgery-related deaths, and no recurrence of
fluid in patients after pericardial window surgery, With our present e
xperience, we advise a subxiphoid pericardial window with pericardial
drainage under local anesthesia for all end-stage renal disease patien
ts on dialysis who have a symptomatic or large pericardial effusion of
more than 300 to 500 mt. Steroid instillation is not necessary for th
e prevention of recurrence of effusion. (C) 1996 by the National Kidne
y Foundation, Inc.