SHOULD PERICARDIAL DRAINAGE BE PERFORMED ROUTINELY IN PATIENTS WHO HAVE A LARGE PERICARDIAL-EFFUSION WITHOUT TAMPONADE

PURPOSE: To assess whether drainage of pericardial effusion by pericar diocentesis or surgery is justified as a routine measure in the initia l management of patients with large pericardial effusion without tampo nade or suspected purulent pericarditis. SUBJECTS AND METHODS: All pat ients with large pericardial effusion without tamponade or suspected p urulent pericarditis who were seen at our institution during a span of 6 years (1990 to 1995) were retrospectively (46) or prospectively (25 ) reviewed. Large pericardial effusion was defined as a sum of echo-fr ee pericardial spaces in diastole exceeding 20 mm. RESULTS: Large peri cardial effusion was diagnosed in 162 patients, 71 of whom fulfilled c riteria for inclusion. Of these, 26 underwent a pericardial drainage p rocedure. Diagnostic yield was 7%, as only 2 specific diagnoses were m ade using these procedures. During follow-up (95% of patients, median 10 months), no patient developed cardiac tamponade or died as a result of pericardial disease, nor did any new diagnoses become manifest in the 45 patients who did not have pericardial drainage initially. Moder ate or large effusions persisted in only 2 of 45 patients managed cons ervatively. CONCLUSIONS: Routine pericardial drainage procedures have a very low diagnostic yield in patients with large pericardial effusio n without tamponade or suspected purulent pericarditis, and no dear th erapeutic benefit is obtained with this approach. Clinical outcomes de pend on underlying diseases, and do not appear to be influenced by dra inage of pericardial fluid. (C) 1998 by Excerpta Medica, Inc.