Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management - Mayo clinic experience, 1979-1998
Tsm. Tsang et al., Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management - Mayo clinic experience, 1979-1998, CHEST, 116(2), 1999, pp. 322-331
Citations number
40
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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.