Volume 5, Issue 4, July 2019, Page: 64-68
Subxiphoid Tube Pericardiostomy in the Management of Pericardial Effusion: Our Experience
Abubakar Umar, Cardiothoracic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Salisu Ismail, Cardiothoracic Surgery Unit, Department of Surgery, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Usman Muhammad Sani, Cardiology Unit, Department of Paediatrics, Usmanu Danfodiyo University/Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Muawiya Usman Zagga, Cardiology Unit, Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Received: Jun. 16, 2019;       Accepted: Jul. 16, 2019;       Published: Sep. 24, 2019
DOI: 10.11648/j.ijcts.20190504.11      View  31      Downloads  9
Introduction – There is minimal amount of fluid within the two layers of the pericardium. This serves to lubricate the layers preventing friction. Various disease processes can lead to increase in the amount of this fluid which cause haemodynamic compromise these patients. Various methods have been used to drain this fluid. We report our experience with subxiphoid tube pericardiotomy in the drainage of pericardial effusion. Material and Method – we reviewed case files of 30 patients that presented to us with pericardial effusion over a six-year period. Results - There were 19 males (63.3%) and 11 females (36.7%). Age range is between 2 yrs and 65 years with a mean of 27.3 yrs. Adult age group accounted for 25 (83.3%) while paediatric age group was 5 (16.7%). Predominant symptom was dyspnea and all patients had subxiphoid tube pericardiostomy for drainage. Majority of our patients (80%) had tuberculosis as the cause of their effusion. Mortality was 3 (10%) following the drainage but cause of death was progression of their disease. The was recurrence in one patient who had malignant effusion and was subsequently treated with pericardial window but later lost to follow up. Conclusion - Subxiphoid tube pericardiostomy still remains the main stay in the management of massive tuberculous pericardial effusion in our environment as it provides the opportunity to drain the fluid and take adequate fluid samples and tissue for diagnosis. Recurrence rate is also low.
Pericardial Effusion, Subxiphoid, Pericardiostomy
To cite this article
Abubakar Umar, Salisu Ismail, Usman Muhammad Sani, Muawiya Usman Zagga, Subxiphoid Tube Pericardiostomy in the Management of Pericardial Effusion: Our Experience, International Journal of Cardiovascular and Thoracic Surgery. Vol. 5, No. 4, 2019, pp. 64-68. doi: 10.11648/j.ijcts.20190504.11
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J 2013; 34: 1186–1197.
Little WC, Freeman GL. Pericardial disease. Circulation 2006; 113: 1622-32.
Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011; 3: 135-43.
Kesieme EB, Okokhere PO, Iruolagbe CO, Odike A, Owobu C, Akhigbe T. Surgical Management of Massive pericardial effusion and predictors for development of constrictive pericarditis in a resource limited setting. Advances in Medicine. 2016: 1-5
Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery—an echocardiographic study. Circulation 1984; 69: 506–511.
Imazio M, Mayosi BM, Brucato A, Markel G, Trinchero R, Spodick DH, Adler Y. Triage and management of pericardial effusion. J Cardiovasc Med (Hagerstown) 2010; 11: 928–935.
Becit N, Ozyazicioglu A, Ceviz M, et al. Clinical experience with subxiphoid pericardiostomy in the management of pericardial effusions: a study of 240 cases. J Int Med Res 2003; 31: 312–7.
Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases. Eur Heart J 2004; 25: 587–610.
Imazio M, Brucato A, Cumetti D, Trinchero R. Corticosteroids for recurrent peri- carditis: high versus low doses: a nonrandomized observation. Circulation 2008; 118: 667–671.
Imazio M. Pericardial involvement in systemic inflammatory diseases. Heart 2011; 97: 1882–1892.
Lindenberger M, Kjellberg M, Karlsson E, et al. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med 2003; 253: 411–7.
Allen KB, Faber LP, Warren WH, et al. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg 1999; 67: 437–40.
Uddin J, Singh MP, Mehdi MD. Study of etiological and clinical profile of pericardial effusion in a tertiary care hospital in Kosi region of Bihar India. Int J Adv Med. 2016; 3 (3): 514-518.
Chen R, Shen T, Tsai K, Hu C (2016) Pericardial window operation for malignant pericardial effusion may have worse outcomes for lung cancer than the other cancers. Research Ideas and Outcomes 2: e8758. doi: 10.3897/rio.2.e8758.
Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does this patient with a pericardial effusion have cardiac tamponade? JAMA 2007; 297: 1810–1818.
Sugimoto JT, Little AG, Ferguson MK, et al. Pericardial window: mechanisms of efficacy. Ann Thorac Surg 1990; 50: 442–5.
Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109: 95-101.
Kil UH, Jung HO, Koh YS, et al. Prognosis of large, symptomatic pericardial effusion treated by echo-guided percutaneous pericardiocentesis. Clin Cardiol 2008; 31: 531-7.
Colombo A, Olson HG, Egan J, Gardin JM. Etiology and prognostic implications of a large pericardial effusion in men. Clin Cardiol. 1988; 11: 389-94.
Corey GR, Campbell PT, Van Trigt P, Kenney RT, O’Connor CM, Sheikh KH, Kisslo JA, Wall TC. Etiology of large pericardial effusions. Am J Med 1993; 95: 209–213.
Spodick DH. Acute cardiac tamponade. N Engl J Med 2003; 349: 684–690.
Reuter H, Burgess LJ, Doubell AF. Epidemiology of pericardial effusions at a large academic hospital in South Africa. Epidemiol Infect 2005; 133: 393–399.
Saito Y, Donohue A, Attai S, Vahdat A, Brar R, Handapangoda I, Chandraratna PA. The syndrome of cardiac tamponade with ‘small’ pericardial effusion. Echocardiography 2008; 25: 321–327.
U. Abubakar, PO Adeoye, OA Adebo, VO Adegboye, E Kesieme and EK Okonta. Pattern of Pericardial Diseases in HIV positive patients as seen in University College Hospital Ibadan, Nigeria. The southern African Journal of HIV Medicine. 2011: 25-26.
Cegielski JP, Ramiya K, Lallinger GJ, Mtulia IA, Mbaga IM. Pericardial disease and human immunodeficiency virus in Dar es Salaam, Tanzania. Lancet. 1990; 335: 209-212.
Stotka JL, Good CB, Downer WR, Kapoor WN. Pericardial effusion and tamponade due to Kaposi’s sarcoma in acquired immunodeficiency syndrome. Chest. 1989; 95: 1359-1361.
Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA. 1986; 256: 362-366.
Saltzman AJ, Paz YE, Rene AG, Green P, Hassanin A, Argenziano MG, et al. Comparison of surgical pericardial drainage with percutaneous catheter drainage for pericardial effusion. J Invasive Cardiol. 2012 Nov. 24 (11): 590-3.
Akyuz S, Zengin A, Arugaslan E, et al. Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion: outcomes over a 10-year period. Herz. 2015 Apr. 40: 153-9.
Callahan JA, Seward JB. Pericardiocentesis Guided by Two-Dimensional Echocardiography. Echocardiography. 1997 Sep. 14 (5): 497-504.
Fitch MT, Nicks BA, Pariyadath M, McGinnis HD, Manthey DE. Videos in clinical medicine. Emergency pericardiocentesis. N Engl J Med. 2012 Mar 22. 366 (12): e17.
Salem K, Mulji A, Lonn E. Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol. 1999 Nov. 15 (11): 1251-5.
Tsang TS, Freeman WK, Barnes ME, et al. Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol. 1998 Nov. 32 (5): 1345-50.
Colak A, Becit N, Kaya U, Ceviz M, Cocak H. Treatment of pericardial effusion through subxiphoid tube pericardiostomy and computerized tomography-or Echocardiography-guided catheter drainage methods. Braz J Cardiovasc Surg 2019; 34 (2): 194-202.
Park CY1, McGonigle NC Single-Port Thoracoscopic Pericardial Window Under Local Anesthesia Innovations. 2018; 13 (1): 62-4.
Montgomerie JZ, Lewis AJ, Fiala M, et al. Pericarditis. West J Med 1975; 122: 295–309.
Quale JM, Lipschik GY, Heurich AE. Management of tuberculous pericarditis. Ann Thorac Surg 1987; 43: 653–5.
Chen Y, Brennessel D, Walters J, et al. Human immunodeficiency virus–associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 1999; 137: 516–21.
Noubiap JJ, Agbor VN, Ndoadoumgue AL, et al. Epidemiology of pericardial diseases in Africa: a systematic scoping review. Heart 2019; 105: 180-188.
Girardi LN, Ginsberg RJ, Burt ME. Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusion. Ann Thorac Surg. 1997 Nov; 64 (5): 1422-7.
Figoli F, Zanette ML, Tirelli U, Sorio R, Lestuzzi C, Urso R, Monfardini S, D'Incalci M. Pharmacokinetics of VM 26 given intrapericardially or intravenously in patients with malignant pericardial effusion. Cancer Chemother Pharmacol. 1987; 20: 239–242.
Markman M, Howell SB. Intrapericardial instillation of cisplatin in a patient with a large malignant effusion. Cancer Drug Deliv. 1985; 2: 49–52.
Davis S, Rambotti P, Grignani F. Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases J Clin Oncol. 1984: 2 (631-6).
Shepherd FA, Morgan C, Evans WK, Ginsberg JF, Watt D, Morphy K. medical management of malignant pericardial effusion by tetracycline sclerosis. Am J Cardiol. 1987: 60; 1161-1166.
Kaira K, Takise A, Kobayashi G, Utsugi M, Horie T, Mori T et al. management of malignant pericardial effusion with instillation of mitomycin C in non-small cell lung cancer. Jopn J Clinc Oncol. 2005: 35; 57-60.
Schusler R, Meyerson SL. Pericardial Disease Associated with Malignancy, Current Cardiology Reports 2018: 20 (92); 1040-5.
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