CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery.
OBJECTIVE
This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery.


METHODS
The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF) <50%. The preintervention ejection fraction was determined echocardiographically with value between 30 and 40%. Exclusion criteria for drainage were hemodynamically unstable patients or impaired coagulation profile (INR <1.8 or platelet count <75,000). Drains (8F-10F) were applied using Seldinger's technique under CT guidance.


RESULTS
Pericardiocentesis and placement of a percutaneous pericardial drain was technically successful in all patients. The mean volume of evacuated pericardial effusion was 260 ml (range 80-900 ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40-55% (mean: 45%; SD: ±5; p < 0.05). The mean percentage increase of the EF following pericardial effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p < 0.05) in comparison to the preventricular position of the catheter. Recorded complications included minimal asymptomatic pneumothorax and pneumomediastinum 2.3% (3/128) and sinus tachycardia 3.9% (5/128).


CONCLUSIONS
CT-guided drainage of postoperative pericardial effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany. nour410@hotmail.com.|Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt. nour410@hotmail.com.
Nour-Eldin Abdelrehim
NA
Nour-Eldin
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.
Mohammed
M
Alsubhi
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.
Tatjana
T
Gruber-Rouh
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.
Thomas J
TJ
Vogl
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.
Benjamin
B
Kaltenbach
Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Hazem Hamed
HH
Soliman
Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Wael Eman
WE
Hassan
Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Sherif Maher
SM
Abolyazid
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.|Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria, Egypt.
Nagy N
NN
Naguib
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging* / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D020519:Pericardiocentesis / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
CT-guided; Cardiac surgery; Drainage; Pericardial effusion