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Journal of the Formosan Medical... Sep 2016
Topics: Aged, 80 and over; Chest Tubes; Drainage; Female; Humans; Medical Errors; Pericardial Effusion; Pericardial Window Techniques; Pneumopericardium; Radiography, Thoracic; Republic of Korea
PubMed: 27117885
DOI: 10.1016/j.jfma.2016.03.003 -
The Annals of Thoracic Surgery Feb 1999Optimal management of cardiac tamponade resulting from pericardial effusion remains controversial. (Comparative Study)
Comparative Study Review
BACKGROUND
Optimal management of cardiac tamponade resulting from pericardial effusion remains controversial.
METHODS
Cardiac tamponade in 117 patients was treated with either subxiphoid pericardiostomy (n = 94) or percutaneous catheter drainage (n = 23). Percutaneous catheter drainage was used for patients with hemodynamic instability that precluded subxiphoid pericardiostomy. Effusions were malignant in 75 (64%) of 117 patients and benign in 42 (36%) of 117.
RESULTS
Subxiphoid pericardiostomy had no operative deaths and a complication rate of 1.1% (1 of 94). In contrast, percutaneous drainage had significantly (p < 0.05) higher mortality and complication rates of 4% (1 of 23) and 17% (4 of 23), respectively. Patients with an underlying malignancy had a median survival of 2.2 months, with a 1-year actuarial survival rate of 13.8%. In comparison, patients with benign disease had a median survival of 42.8 months and a 1-, 2-, and 4-year actuarial survival rate of 79%, 73%, and 49%, respectively (p < 0.05). Effusions recurred in 1 (1.1%) of 94 patients after subxiphoid pericardiostomy compared with 7 (30.4%) of 23 patients with percutaneous drainage (p < 0.0001).
CONCLUSIONS
Benign and malignant pericardial tamponade can be safely and effectively managed with subxiphoid pericardiostomy. Percutaneous catheter drainage should be reserved for patients with hemodynamic instability.
Topics: Cardiac Tamponade; Catheters, Indwelling; Drainage; Humans; Pericardial Effusion; Pericardiectomy; Postoperative Complications; Survival Rate; Treatment Outcome
PubMed: 10197666
DOI: 10.1016/s0003-4975(98)01192-8 -
The Heart Surgery Forum Jan 2004Abstract The classic subxiphoid pericardial window technique and the newer, minimally invasive percutaneous fluoroscopy-controlled method of surgical treatment of...
Abstract The classic subxiphoid pericardial window technique and the newer, minimally invasive percutaneous fluoroscopy-controlled method of surgical treatment of pericardial effusions and/or tamponade are reviewed and compared based on 12 years of surgical experience. Since 1988, 114 patients underwent surgery for treatment of pericardial effusion and/or tamponade. The classic subxiphoid approach was used on 66 patients, and since 1993, the percutaneous tube pericardiostomy method was employed on 48 patients. In choosing a method for pericardial decompression, disease etiology and patient characteristics must be considered as well as the experience of the surgeon.
PubMed: 14980854
DOI: 10.1532/hsf.602 -
Heart Rhythm Jul 2023
Topics: Humans; Epicardial Mapping; Pericardial Window Techniques; Electrocardiography; Tachycardia, Ventricular; Catheter Ablation; Pericardium
PubMed: 37088232
DOI: 10.1016/j.hrthm.2023.04.015 -
Current Cardiology Reports Mar 2016The space that exists between the visceral and parietal pericardium has a small amount of fluid under physiologic conditions. The pericardial layers and this fluid in... (Review)
Review
The space that exists between the visceral and parietal pericardium has a small amount of fluid under physiologic conditions. The pericardial layers and this fluid in combination have a protective role and also offer fluidity of motion and shock absorbance. The pericardium and the fluid can often be involved in pathologies involving the myocardium or sometimes be independently involved in primary diseases of the pericardium with secondary hemodynamic effects. In physiologic and pathologic conditions, invasion of this space by surgical and percutaneous interventions can provide a unique and precious opportunity to enhance patient management in such situations from a diagnostic and therapeutic aspect. This field of "interventional pericardiology" is the focus of this chapter.
Topics: Cardiomyopathies; Catheter Ablation; Epicardial Mapping; Fluoroscopy; Humans; Pericardial Window Techniques; Pericardiocentesis; Pericardium; Radiography, Interventional; Ultrasonography, Interventional
PubMed: 26908116
DOI: 10.1007/s11886-016-0698-9 -
Multimedia Manual of Cardiothoracic... 2015Pericardial effusion may be associated with many diseases, but sometimes its aetiology is not easy to elucidate. Subxiphoid video-pericardioscopy is useful for the study...
Pericardial effusion may be associated with many diseases, but sometimes its aetiology is not easy to elucidate. Subxiphoid video-pericardioscopy is useful for the study of the pericardial cavity. Through a subxiphoid approach, the pericardium is incised and a rigid (usually a video-mediastinoscope) or a flexible endoscope (flexible bronchoscope or flexible choledoscope) is inserted into the pericardial cavity. The inner surface of the parietal pericardium and the epicardium can be explored and biopsies can be taken under visual control. In addition, a subxiphoid pericardial window can be developed, and sclerosing agents instilled for pericardiodesis, if a malignant aetiology is confirmed. In case of pericardial effusion associated with lung cancer, video-pericardioscopy helps to confirm the absence or presence of pericardial tumour implant or infiltration, and to establish the resectability of the tumour. Other than transient arrhythmias during the procedure, video-pericardioscopy has no major complications. When compared with surgical pericardial drainage, video-pericardioscopy has higher sensitivity without specific risks. Rigid endoscopes are the best devices to explore the posterior and lateral pericardial surfaces, the pulmonary veins being the posterior limit of the exploration. Big anterior mediastinal masses and pericardial symphysis may render the exploration impossible.
Topics: Endoscopy; Humans; Pericardial Effusion; Pericardial Window Techniques; Video-Assisted Surgery
PubMed: 26070990
DOI: 10.1093/mmcts/mmv009 -
Cardiac Electrophysiology Clinics Sep 2020The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for... (Review)
Review
The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for epicardial interventions. As the pericardial layers reflect over the great vessels and the heart, they form sinuses and recesses, which restrict catheter movement. The epicardial vasculature is also important when performing nearby catheter ablation. The phrenic nerve and esophagus are other important structures to appreciate so as to avoid collateral injury. In addition, the Larrey space, or left sternocostal triangle, is a key avascular window through which pericardial access can be safely achieved.
Topics: Catheter Ablation; Coronary Vessels; Electrophysiologic Techniques, Cardiac; Esophagus; Humans; Pericardium; Phrenic Nerve
PubMed: 32771181
DOI: 10.1016/j.ccep.2020.04.003 -
The Annals of Thoracic Surgery Jan 2005
Topics: Catheterization; Drainage; Follow-Up Studies; Heart Injuries; Heart Ventricles; Humans; Intraoperative Complications; Pericardial Effusion; Pericardial Window Techniques; Pericardiocentesis; Recurrence; Thoracotomy
PubMed: 15620998
DOI: 10.1016/j.athoracsur.2003.12.085 -
JAAPA : Official Journal of the... Jan 2020Pericarditis is the most common form of pericardial disease and may be associated with significant morbidity and mortality. Management of idiopathic pericarditis... (Review)
Review
Pericarditis is the most common form of pericardial disease and may be associated with significant morbidity and mortality. Management of idiopathic pericarditis includes pharmacologic therapies, non-pharmacologic therapies, and surgery. This article describes the diagnosis and management of idiopathic causes of pericarditis, incorporating recommendations included in the European Society of Cardiology guidelines.
Topics: Acute Disease; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Azathioprine; Colchicine; Disease Management; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Interleukin 1 Receptor Antagonist Protein; Pericardial Window Techniques; Pericarditis; Practice Guidelines as Topic; Recurrence; Tubulin Modulators
PubMed: 31880644
DOI: 10.1097/01.JAA.0000615468.46936.6d -
World Journal of Cardiology Dec 2019Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. PDS usually... (Review)
Review
Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice. Although the precise mechanisms resulting in PDS are not well understood, this seems to be highly associated with patients who have some underlying ventricular dysfunction. Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.
PubMed: 31908728
DOI: 10.4330/wjc.v11.i12.282