Malignant pericardial tamponade.
We studied the clinical course and management of 27 patients with malignant pericardial tamponade seen in a single Medical Center over a 10 year period. Patients treated with repeat pericardial tap as their only mode of therapy had a high rate of recurrent tamponade (6 of 13 subjects) whereas most patients treated with drainage (either surgical or percutaneous) had sustained control of their pericardial effusion (achieved in 10/13 subjects). Intra-pericardial instillation of tetracycline or cyclophosphamide did not clearly improve the good results obtained with drainage alone. Extensive pericardiectomy was required in 2 patients only. Irrespective of the mode of therapy, survival was poor in patients with carcinoma of lung (N = 10) with a median survival of 30 days only vs. 135 days for patients with breast carcinoma (N = 10). Patients with malignant pericardial tamponade are best treated with immediate drainage. Percutaneous and sub-xiphoid surgical drainage are equally effective. Despite invasion of the pericardium by carcinoma, patients with a good oncologic prognosis may enjoy an appreciable survival with adequate quality of life following relief of tamponade.
Rinkevich
D
D
Department of Cardiology, Rambam Medical Center, Technion Faculty of Medicine, Haifa, Israel.
Borovik
R
R
Bendett
M
M
Markiewicz
W
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000209:etiology*; D002423:Cause of Death; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D015996:Survival Rate