Pericardial Decompression

Pericardial tamponade and chronic pericardial effusion were treated in 32 patients by creating a subxiphoid pericardial window under local anesthesia in preference to pericardiocentesis or pericardiectomy. Chest roentgenograms, fluoroscopy, and cardiac catheterization as standard clinical methods of diagnosis have been largely replaced by echocardiography as the most sensitive method for detecting pericardial effusion. Eleven patients had pericarditis of viral, uremic, or purulent origin. Two had intrapericardial hemorrhage following catheter perforation of the heart. Four had pericardial effusion associated with cardiomyopathy and rheumatoid arthritis. In the remaining 15 patients malignancy was the cause of tamponade. In 10 patients we attempted to control the effusion initially with pericardiocentesis. Five of these (50%) required an additional procedure. In 22 patients subxiphoid pericardial decompression was the primary method of treatment; there were no fatalities during or immediately following operation. None of these patients has had any recurrence of tamponade or effusion for up to three years.