title: Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade - one center's experience.
abstract: BACKGROUND
  Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation.
  
  
  OBJECTIVE
  To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center.
  
  
  METHODS
  We performed a retrospective analysis of all consecutive patients referred for treatment in our department in a period of 6 years (15 patients) who underwent emergency pericardial drainage after an echocardiographically proven diagnosis. The procedure of choice was minimally invasive transxiphoid fluid evacuation with routine pericardial drainage. Retrospective operative data analysis was performed: clinical symptoms, pre-admission and initial emergency diagnostics and interventions, the morphology and total amount of drained pericardial fluid, length of stay, final results, and overall survival rate. We introduced an original pediatric tamponade index (PTI). The PTI was analyzed according to catecholamine support before the drainage and the length of hospital stay after the procedure.
  
  
  RESULTS
  All patients survived the procedure. No early complications of the presented minimally invasive subxiphoid approach were noted. Mean PTI in patients with intensive catecholamine support before the operation was significantly higher than in patients without it.
  
  
  CONCLUSIONS
  Minimally invasive surgical transxiphoid interventions appear to be a safe and effective method to provide life-saving support with retrieval of the fluid for further laboratory investigations.
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland ; Chair of Physiotherapy, Gdansk Academy of Physical Education and Sport, Gdansk, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Ewelina
authors.initials: E
authors.lastname: Kwasniak
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Jaworski
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Steffens
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Aneta
authors.initials: A
authors.lastname: Sendrowska
authors.affiliation: Department of Rehabilitation, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gierat-Haponiuk
authors.affiliation: Department of Obstetrics, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Leszczyńska
authors.affiliation: Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Paczkowski
authors.affiliation: Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Zielinski
keywords: cardiac tamponade; chest trauma; pediatric cardiac surgery; viral infections