A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion. A follow-up report.
OBJECTIVE
This study was designed to determine the cause of large pericardial effusions and evaluate the efficacy of subxiphoid pericardiotomy.


BACKGROUND
Despite great advances in the techniques used to diagnose pericardial effusions, much controversy remains concerning their cause and the optimal treatment of these effusions.


METHODS
In a prospective consecutive case series, 57 patients underwent a thorough preoperative evaluation followed by a subxiphoid pericardiotomy. All tissue and fluid was exhaustively evaluated. Postoperatively, all patients were followed for a least 1 year.


RESULTS
Surgery was performed under local anesthesia in 77% of patients, and the complications of surgery were minimal. Pericardial tissue and fluid established or aided in establishing a diagnosis in 81% of patients. Infection and malignancy were the leading causes; the condition in only 4 patients remained undiagnosed. Follow-up revealed recurrent effusion in nine (16%) patients, but only five (9%) required further surgery. The mortality rate at 30 days was 12%, and at 1 year, it was 37%. Fourteen of the 21 deaths occurred in patients with malignancies.


CONCLUSIONS
These data show that the cause of most large pericardial effusions can be determined by a thorough evaluation accompanied by subxiphoid pericardiotomy. In addition, subxiphoid pericardial biopsy and window creation is safe and effective in the treatment of these effusions.
Van Trigt
P
P
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Douglas
J
J
Smith
P K
PK
Campbell
P T
PT
Wall
T C
TC
Kenney
R T
RT
O'Connor
C M
CM
Sheikh
K H
KH
Corey
G R
GR
D001706:Biopsy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D010490:Pericardial Effusion / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D010492:Pericardiectomy / Q000379:methods*; D010496:Pericardium / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D014989:Xiphoid Bone