Etiology,Management, and Outcome of Pediatric Pericardial Effusions

The objective of this study was to determine the contemporary etiologies, treatment, and outcomes of moderate and large pericardial effusions in pediatric patients. We reviewed pediatric patients with moderate or large effusions diagnosed at Children's Hospital Boston. Effusion size was determined in offline review of echocardiograms. One hundred sixteen patients with moderate or large pericardial effusions were identified. The age range was 1 day to 17.8 years (median 8.6). The size of the pericardial effusions ranged from 0.5 to 4.7 cm (median 2.1). Neoplastic disease was present in 39% of patients, collagen vascular disease in 9%, renal disease in 8%, bacterial infection in 3%, and human immunodeficiency virus (HIV) in 2%; 37% were idiopathic. Pericardial drainage procedures were performed in 47 patients (41%). Of these, 29 (63%) had recurrent effusions leading to repeat drainage in 12 (41%). Pericardial effusions resolved within 3 months in 83% of patients who underwent drainage and in 91% of patients who did not. In summary, pediatric pericardial effusions were rarely caused by bacterial infections in this study population and were more frequently idiopathic or associated with neoplastic disease. Pericardial effusions often reaccumulated after drainage. The majority of both drained and undrained effusions resolved within 3 months.     

Post-medistinoscopy chylopericardium

Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy. Six days after being discharged, he developed dyspnoea and chest pain. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was done and surprisingly revealed milky white chylous fluid. The patient was then successfully managed without the need for further intervention.     

改良中心静脉导管留置治疗心包积液80例临床评价

目的探讨改良中心静脉导管对中、大量心包积液进行心包穿刺置管引流的方法以寻求一种安全、有效、经济的治疗措施。方法患者取半卧位，超声心动图定位穿刺点。53例患者经剑突下进针，27例患者经左侧胸壁进针。采用Sendinger’s法，将改良中心静脉导管送入心包腔内，连接无菌引流袋引流积液。结果80例患者心包穿刺均获成功，未出现并发症。引流导管留置时间3～17d，平均14d。引流积液量700～2600ml（平均1228ml）。穿刺引流后患者胸闷、气短明显改善，休克征象消失，心率减低，心功能亦获明显改善。结论改良中心静脉导管心包积液穿刺置管引流术安全，可避免损伤心肌，留置导管可使引流彻底，避免堵塞，疗效可靠。     

塞尔丁格法心包穿刺置管引流术治疗急诊大量心包积液临床分析

目的探讨急诊塞尔丁格(Seldinger)法心包穿刺置管术的疗效及安全性。方法急诊大量心包积液合并有填塞症状的患者23例,按急诊来诊顺序分为常规穿刺组10例、塞尔丁格法组13例,塞尔丁格法组采用塞尔丁格法心包穿刺置管引流术,常规穿刺组采用传统的心包穿刺抽液术治疗,比较两组患者治疗前后症状变化,治疗后超声下心包内积液厚度变化情况,以及手术并发症。结果塞尔丁格法组患者均只行1次穿刺引流术,引流液总量约800~1500ml;常规穿刺组行2~3次穿刺抽液,抽液总量约700~1200ml。塞尔丁格法组患者症状缓解较明显。但两组患者引流术后的生理参数(心率、脉压差、呼吸频率和血氧饱和度)变化无统计学意义。治疗后复查超声示塞尔丁格法组心包内残留液体量少于常规穿刺组(P<0.05)。常规穿刺组术中出现室性早搏3例,塞尔丁格法组未见手术并发症。结论采用塞尔丁格法穿刺置管引流术可有效彻底引流心包内积液,安全性好,值得临床推广应用。     

进行心包穿刺和引流的心包积液患者的临床特点分析

目的：探讨需要进行心包穿刺和引流的心包积液患者的临床特征,以指导该类患者的诊断和治疗。方法：总结并分析202例需要进行心包穿刺和引流的心包积液患者的临床特征、病因及心包积液性质。结果：除11例急性心肌梗死患者来不及进行心包穿刺外,191例均成功进行心包穿刺和引流,漏出液12例,渗出液179例。渗出液中,肿瘤性77例,结核性62例,医源性18例,急性心肌梗死15例,结缔组织疾病10例。77例肿瘤性心包积液中,肺癌42例,乳腺癌7例,原发灶暂时不明确的转移性腺癌6例,淋巴瘤7例,肝癌4例,纵隔瘤3例,胃癌、膀胱癌、直肠癌、心包肉瘤、横纹肌肉瘤、黑色素瘤、恶性胸腺瘤和心脏血管瘤各1例。18例医源性心包积液中,心律失常导管消融者10例,经皮冠状动脉介入治疗者6例。心律失常导管消融并发医源性心包积液的比例女性高于男性、房颤患者高于非房颤患者。9例导管消融者行心包穿刺和引流即可,余9例医源性心包积液还需外科修补。15例急性心肌梗死者在住院期间均死亡。结论：需要进行心包穿刺和引流的心包积液多为渗出液及血性,肿瘤和结核为主要原因,注意识别和鉴别医源性心包积液和急性心肌梗死,积极心包穿刺和引流是重要的治疗手段。     

射频导管消融术并发心脏压塞的临床分析

目的 通过分析射频消融术并发心脏压塞的临床特点，为预防及治疗这个并发症提供临床经验。方法 对发生心脏压塞的患者的临床资料进行回顾性分析，探讨可能的机制并提出预防措施。结果 850例接受射频消融治疗的患者中，4例发生心脏压塞。其中3例为老年患者，平均年龄67岁，1例为8岁儿童。所有患者均为左侧旁路，左前侧2例，左后侧2例。术中常规放置冠状静脉窦电极导管并经主动脉逆行插管进行射频消融，常规使用了肝素。发生心脏压塞后4例患者均给予心包穿刺，2例进行了外科开胸手术，1例经剑突下直接切开心包。术中证实2例为冠状静脉窦破裂，1例为左心室游离壁穿孔。结论 射频消融术中心脏压塞多发于左侧旁路的老年患者，冠状静脉窦破裂是最常见的原因，也与不恰当心室内导管操作及肝素使用有关。发生心脏压塞后即刻行心包穿刺是维持生命及后续治疗的必要保证。穿刺后仍不能维持血压则应尽早开放心包减压。     

超声引导下心包积液穿刺及置管引流的临床研究

目的探讨超声引导下心包积液穿刺及置管引流的临床应用价值。方法176例心包积液患者，行超声检查确定心包积液程度，并设定穿刺路线。局麻下采用18G PTC穿刺针或16GEV穿刺针在超声引导下进入心包腔抽吸液体，必要时置管引流。结果176例心包积液均穿刺成功，并发症1例（0．57％），为快速房颤。结论超声引导下心包积液穿刺及置管引流安全、准确、有效，有较高临床应用价值。     

Delayed cardiac tamponade: A rare but life-threatening complication of catheter ablation

Delayed cardiac tamponade (DCT) is a rare and life-threatening complication of catheter ablation performed as a treatment of atrial fibrillation, with few cases described in the medical literature. We present the case of a 57 year-old man presenting with DCT 61 days following a catheter ablation procedure. To the best of our knowledge, this is the most delayed case of cardiac tamponade (CT) following catheter ablation described in the literature. We also discuss the importance of point of care ultrasound (POCUS) in the diagnosis and treatment of CT.Emergency physicians must maintain a high index of suspicion in making the diagnosis of CT as patients may present with vague symptoms such as neck or back pain, shortness of breath, fatigue, dizziness, or altered mental status, often without chest pain.Common risk factors for CT include cancer, renal failure, pericarditis, cardiac surgery, myocardial rupture, trauma, and retrograde aortic dissection. In addition, although rare, both catheter ablation and use of anticoagulation carry risks of developing CT. A worldwide survey of medical centers performing catheter ablation found CT as a complication in less than 2% of cases [1]. Some proposed mechanisms of DCT include small pericardial hemorrhages following post-procedural anticoagulation or rupture of the sealed ablation-induced left atrial wall [2].Clinical examination and electrocardiography may be helpful. However, the criterion standard for diagnosing CT is echocardiography [3].     

心包穿刺硅胶管引流103例经验总结

目的　探讨安全心包穿刺引流、并有效治疗心包积液的方法。方法　将经穿刺并硅胶管引流的 10 3例资料与同期单纯心尖部穿刺的 30例资料进行比较。结果　引流组 30例 (30 / 35 )肿瘤性积液、2 5例 (2 5 / 2 9)结核性积液、16例(16 / 16 )特发性渗出性积液、2例 (2 / 2 )化脓性心包炎经引流与心包内注药后积液消失 ,引流组其余病因的积液也获得有效缓解 ;而单纯穿刺组仅暂时缓解症状 ,大部分积液及压塞未缓解而转入引流组。操作相关的并发症以后者为多。采用Seldinger导管法穿刺引流 ,在床边不需两维超声指引 ,安全可靠。硅胶管与组织相容性好 ,可长时间保留心包内引流(1～ 82天 )。结论　本方法简单、安全、有效 ,可有效引流及治疗心包积液。Seldinger导管法用于心包穿刺引流安全可靠。