Closed pericardial drainage for relief of pericardial tamponade

The method of continuous catheter drainage for pericardial tamponade as used in 108 patients is described. The efficacy of this procedure in relieving tamponade resulting from a variety of diseases is demonstrated. Blood clot in the pericardium probably constitutes a contraindication to catheter drainage.     

心包穿刺置管引流术的临床应用体会

~~心包穿刺置管引流术的临床应用体会@刘俊明!830002$新疆乌鲁木齐市兵团医院心内科 @黄文军!830002$新疆乌鲁木齐市兵团医院心内科 @李辉!830002$新疆乌鲁木齐市兵团医院心内科 @谢伟!830002$新疆乌鲁木齐市兵团医院心内科 @高霞!830002$新疆乌鲁木齐市兵团医院心内科 @刘志强!830002$新疆乌鲁木齐市兵团医院心内科     

Hemorrhagic pericardial effusion causing pericardial tamponade in hereditary hemorrhagic telangiectasia

Osler-Weber-Rendu disease, or Hereditary Hemorrhagic Telangiectasia (HHT), is a rare, inherited autosomal dominant disorder characterized by telangiectasia and arteriovenous malformations in various organs. We report a unique case of HHT-associated hemorrhagic pericardial effusion presenting with pericardial tamponade.     

Primary pericardial sarcoma

We present the case of a 50 years old male revealed by a recurrent pericardial effusion. The diagnosis of malignancy was confirmed by direct biopsy. The treatment consisted in surgical excision and chemotherapy. The patient was asymptomatic 17 months after surgery.     

Post-traumatic pericardial calcification

Trauma is a cause of calcific constrictive pericarditis, but less commonly may cause a localized mass. We report such a case in which the mass impinged on the right heart resulting in severe systemic venous stasis.     

Procainamide-induced pericardial effusion

A case of hemodynamically significant pericardial effusion due to a procainamide-induced SLE-like syndrome is reported. This case emphasizes that the acute pleuropericardial syndrome seen after procainamide therapy is potentially dangerous. Close follow-up of patients taking procainamide is warranted.     

Large pericardial effusions

Opinion statement Pericardial effusions accompany a number of clinical conditions. The challenges facing the clinician when dealing with a pericardial effusion include assessing the urgency of draining the effusion, choosing the right approach for drainage, determining the mechanics of the effusion, and establishing a cause for the effusion. Currently avail-able diagnostic methods, echocardiographic modalities in particular, greatly aid in the diagnostic assessment as well as in carrying out appropriate therapeutic strategies.     

Purulent pericardial effusion

A fatal case of purulent pericardial effusion in which the patient was treated with sulfadiazine and penicillin is presented.     

Neoplastic pericardial effusion

Neoplastic pericardial effusion is a serious and common clinical disorder encountered by cardiologists, cardiothoracic surgeons, oncologists, and radiation oncologists. It may develop from direct extension or metastatic spread of the underlying malignancy, from an opportunistic infection, or from a complication of radiation therapy or chemotherapeutic toxicity. The clinical presentation varies, and the patient may be hemodynamically unstable in the setting of constrictive pericarditis and cardiac tamponade. The management depends on the patient's prognosis and varies from pericardiocentesis, sclerotherapy, and balloon pericardiotomy to cardiothoracic surgery. Patients with neoplastic pericardial effusion face a grave prognosis, as their malignancy is usually more advanced. This review article discusses the epidemiology and etiology, pathophysiology, clinical presentation, diagnosis, management, and prognosis of neoplastic pericardial effusion.     

Neoplastic pericardial disease

The spread of metastatic cancer to the pericardium is the most common cause of cardiac tamponade in medical inpatient settings. Lung cancer, breast cancer, and the hematologic malignancies account for some three quarters of the cases. Occasionally, usually in lung cancer, the pericardial involvement is the first clinical presentation of the neoplastic disease. Differential diagnosis includes radiation pericarditis and cardiac toxicity from chemotherapeutic drugs, as well as any of the causes of pericardial disease in patients without neoplasm. Idiopathic nonneoplastic, noninflammatory pericardial effusion is surprisingly common in cancer patients. The initial cardiac tamponade may be managed with either needle tap or subxiphoid pericardiostomy. Pericardiocentesis, performed with echocardiographic guidance and followed by percutaneous catheter drainage for several days, is safe and effective in neoplastic pericardial effusion. It may be the only local therapy that is needed. Further local treatment, for those patients who develop recurrent cardiac tamponade after an initial drainage procedure, may include tetracycline sclerosis of the pericardial space, instillation of cancer chemotherapeutic agents, radiation therapy, and pericardiectomy. No controlled clinical trials of these methods of treatment are available. The choice of therapy is based on various considerations in individual patients, particularly the patient's general condition and the likelihood of a long-term response to treatment of the systemic neoplastic disease.