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The Journal of Cardiovascular Surgery 2002 October;43(5):735-9

language: English

Which treatment in pericardial effusion?

Campione A. 1, Cacchiarelli M. 2, Ghiribelli C. 1, Caloni V. 2, D’Agata A. 1, Gotti G. 1

1 Tho­racic Sur­gery ­Unit Uni­ver­sity Hos­pital of ­Siena, ­Siena, ­Italy
2 Tho­racic Sur­gery ­Unit ASL 8, ­Arezzo, ­Italy


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Back­ground. Per­i­car­di­o­cen­tesis, ­pleuro-per­i­car­dial ­window, subx­i­phoid per­i­car­dial ­drainage and per­i­car­di­os­copy: ­which meth­o­dology to ­treat per­i­car­dial effu­sion? ­Each of ­these sur­gical treat­ments can be effec­tive, ­depending on clin­ical fac­tors and his­tory of the ­patients. We con­sid­ered per­i­car­dial effu­sions ­during 5 ­years.
­Methods. We ­reviewed 64 ­cases: 14 ­acute per­i­car­dial effu­sions (5 ­patients ­with car­diac tam­po­nade), 39 sub­acute, 11 ­chronic. Epi­dem­i­ology and aetio­logy: 8 ­cases ­were ­between 20 and 25 ­years old (all ­affected by lym­phoma), 56 ­were dis­trib­uted in ­every age, espe­cially ­over 60, and of ­these 45 ­were neo­plastic and 11 non- neo­plastic. Non-neo­plastic ­cases ­were con­nec­tiv­itis (3 ­patients), uncer­tain ­origin effu­sion (7 ­patients), tuber­cular (1 ­patient). In neo­plastic effu­sions we ­found lym­phoma (at ­older age) in 7, ­small ­cell ­lung ­cancer in 6, ­NSCLC in 12, mesoth­e­lioma in 2, ­breast ­cancer in 7.
­Results. ­Acute per­i­car­dial effu­sions ­with car­diac tam­po­nade under­went ­echo-­guided per­i­car­di­o­cen­tesis. In 43 we had a subx­i­phoid per­i­car­dial ­drainage, ­among ­these ­cases we per­formed 4 per­i­car­di­os­co­pies. We ­created a ­pleuro-per­i­car­dial ­window on ­VATS in 13, on thor­a­cotomy in 4 for tech­nical rea­sons.
Con­clu­sions. Per­i­car­di­o­cen­tesis is to be pre­ferred in ­acute per­i­car­dial effu­sion ­with car­diac tam­po­nade to ­avoid gen­eral ­anaesthesia. ­Pleuro-per­i­car­dial ­window on ­VATS is ­better in ­chronic per­i­car­dial effu­sion (for infec­tive or ­systemic dis­ease) and in recur­rence, ­after per­forming subx­i­phoid ­drainage. Subx­i­phoid ­drainage is suit­able for all neo­plastic ­patients, and in ­case of ­unknown aetio­logy in ­order to per­form a per­i­car­di­os­copy.

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