Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management - Mayo clinic experience, 1979-1998

Study objectives: This Study assessed the clinical features, timing of pres entation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcome s of echocardiographically (echo-) guided pericardiocentesis for the manage ment of these effusions were evaluated. Design: From the prospective Mayo Clinic Registry of Echo-guided Pericardio centesis (February 1979 to June 1998), 245 procedures performed for clinica lly significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic s urgical database provided an estimate of the incidence of significant posto perative effusions and the number of cases in which primary surgical manage ment was chosen instead of pericardiocentesis, Results: Use of anticoagulant therapy was considered a significant contribu ting factor in 86% and 65% of early effusions (less than or equal to 7 days after surgery) and late effusions (> 7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of l ate effusions (34%). Common presenting symptoms included malaise (90%), dys pnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular veno us pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permit ted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation . Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow- up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reductio n in recurrence for early and late postoperative effusions by 46% and 50%, respectively. Conclusions: The symptoms and physical findings of clinically significant p ostoperative pericardial effusions are frequently nonspecific and ma be ina dequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocard iographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the m ajority of patients so treated do not require further intervention.