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Journal of the American Heart... Dec 2017Pericardial effusions can be caused by a variety of disorders. The frequency of the underlying diseases varies with patient population; therefore, previously reported... (Observational Study)
Observational Study
BACKGROUND
Pericardial effusions can be caused by a variety of disorders. The frequency of the underlying diseases varies with patient population; therefore, previously reported series are not necessarily representative of other populations. Our purpose was to examine the etiology of pericardial effusions and the survival of patients requiring pericardiocentesis at a tertiary center.
METHODS AND RESULTS
We performed a retrospective observational study of 269 consecutive patients who underwent percutaneous pericardiocentesis at our university hospital between 2006 and 2016 and had prospective follow-up for up to 10 years. The most frequent etiologies were idiopathic (26%), malignancy (25%), and iatrogenicity (20%), whereas bacterial causes were very rare. The most frequent malignancies originated from the lung (53%) or breast (18%). A new cancer was diagnosed with malignant pericardial effusion as the presenting complaint for 9% of patients, whereas the pericardium was the first metastatic site of a known malignancy in 4% of patients. Survival was significantly poorer in malignancy-related versus non-malignancy-related effusions (<0.001) and in cytology-positive versus cytology-negative effusions in the overall cohort (<0.001). Among cancer-only patients, however, there was no significant difference in long-term survival between cytology-positive and -negative effusions.
CONCLUSIONS
In this contemporary tertiary-center cohort, pericardial effusions often represent the primary instance of a new malignancy, underscoring the importance of cytological analyses of noniatrogenic effusions in patients without known cancer, as survival is significantly worse. In cancer patients, however, the presence of pericardial malignant cytology does not appear to affect outcome significantly.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Pericardium; Prospective Studies; Retrospective Studies; Young Adult
PubMed: 29275375
DOI: 10.1161/JAHA.117.007598 -
Indian Journal of Thoracic and... Jul 2019Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without...
Pneumopericardium is the presence of air in the pericardial cavity. It is a rare case entity that has been reported most commonly after trauma, or spontaneously without any underlying cause in a healthy adult. Pneumopericardium following pericardiocentesis has been rarely reported in the literature. Pneumopericardium is often self-resolving and rarely requires a pericardial drain for treatment. We report a case of pneumopericardium presented with tamponade physiology following pericardiocentesis for tubercular pericardial effusion, requiring emergency pericardiectomy.
PubMed: 33061035
DOI: 10.1007/s12055-018-00785-9 -
Journal of the American College of... Aug 2016
Topics: Cardiac Tamponade; Echocardiography; Female; Fluoroscopy; Hematologic Neoplasms; Humans; Male; Pericardiocentesis; Retrospective Studies; Thrombocytopenia
PubMed: 27515340
DOI: 10.1016/j.jacc.2016.05.068 -
Anales de Pediatria Aug 2023
Topics: Pericardiocentesis; Ultrasonography; Ultrasonography, Interventional
PubMed: 37474419
DOI: 10.1016/j.anpede.2023.07.001 -
JACC. Cardiovascular Imaging Apr 2018This study sought to investigate the incidence, associated findings, and natural history of effusive-constrictive pericarditis (ECP) after pericardiocentesis.
OBJECTIVES
This study sought to investigate the incidence, associated findings, and natural history of effusive-constrictive pericarditis (ECP) after pericardiocentesis.
BACKGROUND
ECP is characterized by the coexistence of tense pericardial effusion and constriction of the heart by the visceral pericardium. Echocardiography is currently the main diagnostic tool in the assessment of pericardial disease, but limited data have been published on the incidence and prognosis of ECP diagnosed by echo-Doppler.
METHODS
A total of 205 consecutive patients undergoing pericardiocentesis at Mayo Clinic, Rochester, Minnesota, were divided into 2 groups (ECP and non-ECP) based on the presence or absence of post-centesis echocardiographic findings of constrictive pericarditis. Clinical, laboratory, and imaging characteristics were compared.
RESULTS
ECP was subsequently diagnosed in 33 patients (16%) after pericardiocentesis. Overt clinical cardiac tamponade was present in 52% of ECP patients and 36% of non-ECP patients (p = 0.08). Post-procedure hemopericardium was more frequent in the ECP group (33% vs. 13%; p = 0.003), and a higher percentage of neutrophils and lower percentage of monocytes were noted on pericardial fluid analysis in those patients. Clinical and laboratory findings were otherwise similar. Baseline early diastolic mitral septal annular velocity was significantly higher in the ECP group. Before pericardiocentesis, respiratory variation of mitral inflow velocity, expiratory diastolic flow reversal of hepatic vein, and respirophasic septal shift were significantly more frequent in the ECP group. Fibrinous or loculated effusions were also more frequently observed in the ECP group. Four deaths occurred in the ECP group; all 4 patients had known malignancies. During median follow-up of 3.8 years (interquartile range: 0.5 to 8.3 years), only 2 patients required pericardiectomy for persistent constrictive features and symptoms.
CONCLUSIONS
In a large cohort of unselected patients undergoing pericardiocentesis, 16% were found to have ECP. Pre-centesis echocardiographic findings might identify such patients. Long-term prognosis in those patients remains good, and pericardiectomy was rarely required.
Topics: Aged; Anti-Inflammatory Agents; Echocardiography, Doppler; Female; Hemodynamics; Humans; Incidence; Male; Middle Aged; Minnesota; Pericardial Effusion; Pericardiectomy; Pericardiocentesis; Pericarditis, Constrictive; Prognosis; Retrospective Studies; Time Factors; Ventricular Function, Left
PubMed: 28917680
DOI: 10.1016/j.jcmg.2017.06.017 -
BMJ Case Reports Aug 2011A 19-year-old male presented with recurrent episodes of pericardial effusion. On evaluation, he was diagnosed to have idiopathic chylous effusion. As there was...
A 19-year-old male presented with recurrent episodes of pericardial effusion. On evaluation, he was diagnosed to have idiopathic chylous effusion. As there was persistent pericardial collection, chemical pericardiodesis was done. Following pericardiodesis, there was no recurrence of pericardial effusion. Chemical pericardiodesis may be an effective treatment option for recurrent, idiopathic chylopericardium.
Topics: Diagnosis, Differential; Humans; Male; Pericardial Effusion; Pericardiocentesis; Recurrence; Tomography, X-Ray Computed; Young Adult
PubMed: 22678944
DOI: 10.1136/bcr.07.2011.4520 -
Frontiers in Cardiovascular Medicine 2023Percutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source....
BACKGROUND
Percutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source. The study aimed to analyze the clinical characteristics of patients subject to pericardiocentesis and the predictors of in-hospital mortality.
METHODS
The study represents a registry that covered consecutive patients undergoing percutaneous pericardiocentesis from 2011 to 2022 in high-volume tertiary reference center. Electronic health records were queried to obtain demographic and clinical variables. The primary endpoint was in-hospital mortality, while secondary endpoint was the need for recurrent pericardiocentesis.
RESULTS
Out of 132 456 patients hospitalized in the prespecified period, 247 patients were subject to percutaneous pericardiocentesis (53.9% women; median age of 66 years) who underwent 273 procedures. In-hospital death was reported in 14 patients (5.67%), while recurrent pericardiocentesis in 24 patients (9.72%). Iatrogenic cause was the most common etiology (42.5%), followed by neoplastic disease (23.1%) and idiopathic effusion (14.57%). In logistic regression analysis in-hospital mortality was associated with myocardial infarction (MI)-related etiology ( = 0.001) and recurrent/persistent cardiogenic shock ( = 0.001).
CONCLUSIONS
Iatrogenic etiology and neoplastic disease seem to be the most common indications for pericardiocentesis, while in-hospital mortality was particularly high in patients with spontaneous tamponade in the course of MI.
PubMed: 37781300
DOI: 10.3389/fcvm.2023.1252525 -
Journal of Clinical and Translational... Jun 2023The clinical course of malignancies is frequently complicated by third spacing in body cavities, including pericardial effusion. What remains the optimal management for...
BACKGROUND
The clinical course of malignancies is frequently complicated by third spacing in body cavities, including pericardial effusion. What remains the optimal management for malignant pericardial effusion is a dilemma.
AIM
We aimed to compare 30-day outcomes of imaging-guided pericardiocentesis and surgical pericardial window in patients with malignant pericardial effusion.
METHODS
A retrospective observational study was done at a tertiary care hospital. We reviewed hospital record files of 91 consecutive patients admitted with malignant pericardial effusion from January 2010 to December 2019 and requiring imaging-guided pericardiocentesis or pericardial window.
RESULTS
A total of 71 patients were included in the final analysis. Most patients were male (68%). The mean age was 45 years. Hypertension was the most common comorbid condition. Lymphoma or leukemia (39%) was the most common cause of malignant pericardial effusion followed by lung cancer (28%). About 57.7% of patients underwent pericardiocentesis, and the remainder underwent surgical pericardial window (42.3%). The overall procedural success was 97.2%, and the overall mortality was 5.6%. The success rate was similar when pericardiocentesis was compared with the surgical pericardial window ( = 0.22). The length of hospital stay was higher in patients undergoing pericardial window ( = 0.007), whereas the re-accumulation rate was higher in the pericardiocentesis group (0% versus 34%, < 0.001). Patients undergoing pericardial window had higher odds of major bleeding requiring transfusions.
CONCLUSION
There is a higher rate of recurrence following isolated pericardiocentesis but a comparable mortality difference between the two procedures. Complication rates can be reduced by improving surgical technique and peri-operative management. Meticulous surgical care, infection precautions, and good glycemic control in this immunocompromised subset can preserve the pericardial window as a better management option.
RELEVANCE TO PATIENTS
Pericardial window is a promising and effective management option for patients with recurrent malignant pericardial effusion, but it comes at the cost of bleeding and infection. More extensive trials are needed to understand better the long-term outcomes of pericardial window or pericardiocentesis in patients with malignant effusion.
PubMed: 37457544
DOI: No ID Found -
BMJ Case Reports Feb 2018A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold...
A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold clammy skin, raised jugular venous pressure and muffled heart sounds and was diagnosed to have cardiac tamponade, later confirmed on two-dimensional echocardiography. However, patient had bradycardia, and the other striking examination findings were coarse facies with pallor, madarosis, absent axillary and pubic hair and breast atrophy. Her blood sugar level was also low. Detailed history revealed an episode of postpartum haemorrhage with lactation failure and early menopause. Pericardiocentesis was done with a pig-tail catheter. Hormone profile and MRI brain confirmed the diagnosis of Sheehan's syndrome. Patient improved on treatment with thyroxine and hydrocortisone supplementation and was discharged with education about stress dosing.
Topics: Bradycardia; Brain; Cardiac Tamponade; Diagnosis, Differential; Echocardiography; Female; Heart; Humans; Hydrocortisone; Hypopituitarism; Magnetic Resonance Imaging; Middle Aged; Pericardial Effusion; Pericardiocentesis; Pituitary Hormones; Radiography; Syndrome; Thyroxine
PubMed: 29431100
DOI: 10.1136/bcr-2017-223129 -
Journal of Korean Medical Science Mar 2016Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but...
Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
Topics: Aged; Cardiac Tamponade; Drainage; Dyspnea; Emergency Medical Services; Heart Ventricles; Humans; Male; Medical Errors; Pericardial Effusion; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 26952636
DOI: 10.3346/jkms.2016.31.3.470