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A Jain - One of the best experts on this subject based on the ideXlab platform.
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percutaneous balloon pericardiotomy for recurrent malignant Pericardial Effusion
Journal of Thoracic Oncology, 2011Co-Authors: Daniel A Jones, A JainAbstract:An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large Pericardial Effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous Pericardial Effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A–D) (Supplemental Digital Content 2– 4, http://links.lww.com/JTO/A158, http://links.lww.com/JTO/A160, and http://links.lww.com/ JTO/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable Effusion with no diastolic right atrium/right ventricle/collapse. Malignant disease is a common cause of Pericardial Effusion with incidences ranging from 1 to 20% in all cancer patients.1,2 Management is challenging with recurrence rates of 13 to 50%3 after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain Pericardial Effusions.
Yiufai Cheung - One of the best experts on this subject based on the ideXlab platform.
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Pericardial Effusion after open heart surgery for congenital heart disease
Heart, 2003Co-Authors: Eddie W Y Cheung, S A Ho, K K Y Tang, A K T Chau, C S W Chiu, Yiufai CheungAbstract:Objectives: To determine the prevalence and time course of Pericardial Effusion after open heart surgery for congenital heart diseases and to identify predisposing risk factors. Design and patients: Prospective assessment of development of Pericardial Effusion in 336 patients (163 males) undergoing open heart surgery for congenital heart disease by serial echocardiography on days 5, 7, 14, 21, and 28 postoperatively. Setting: Tertiary paediatric cardiac centre. Results: The prevalence of Pericardial Effusion was 23% (77 of 336). Of the 77 patients who developed Effusion, 43 (56%) had moderate to large Effusions and 18 (23%) were symptomatic. Patients who had a large amount of Effusion were more likely to be symptomatic than those with only a small to moderate amount (47.4% v 15.5%, p = 0.01). The mean (SD) onset of Pericardial Effusion was 11 (7) days after surgery, with 97% (75 of 77) of cases being diagnosed on or before day 28 after surgery. The prevalence of Effusion after Fontan-type procedures (60%, 6 of 10) was significantly higher than that after other types of cardiac surgery: repair of left to right shunts (22.1%, 43 of 195), repair of lesions with right ventricular outflow tract obstruction (22.6%, 19 of 84), arterial switch operation (6.7%, 1 of 15), and miscellaneous procedures (25%, 8 of 32) (p = 0.037). Univariate analyses showed that female patients (p = 0.009) and those receiving warfarin (p = 0.002) had increased risk of postoperative Pericardial Effusion. A greater Pericardial drain output in the first four hours after surgery also tended to be significant (p = 0.056). Multivariate logistic regression similarly identified warfarin treatment (β = 1.73, p = 0.009) and female sex (β for male = −0.63, p = 0.037) as significant determinants. Conclusions: Pericardial Effusion occurs commonly after open heart surgery for congenital heart disease. Serial echocardiographic monitoring up to 28 days postoperatively is indicated in selected high risk patients such as those with symptoms of postpericardiotomy syndrome and those given warfarin.
Hiromichi Suzuki - One of the best experts on this subject based on the ideXlab platform.
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successful use of thoracoscopic pericardiectomy in elderly patients with massive Pericardial Effusion caused by uremic pericarditis
American Journal of Kidney Diseases, 2001Co-Authors: Hidetomo Nakamoto, Toshihiko Suzuki, Souichi Sugahara, Hirokazu Okada, Koichi Kaneko, Hiromichi SuzukiAbstract:We report the use of thoracoscopic pericardiectomy to treat two elderly patients with massive Pericardial Effusion caused by uremic pericarditis. A 79-year-old man, admitted to our hospital complaining of dyspnea, was diagnosed with end-stage renal failure and began maintenance hemodialysis. Although intensive hemodialysis was performed, the patient could not remain on hemodialysis because of severe hypotension during the procedure. Echocardiography revealed massive Pericardial Effusion and severe hypokinesis of the left ventricular wall. Pericardiocentesis was performed first, without success, followed by thoracoscopic pericardiectomy under general anesthesia. One month after the pericardiectomy, episodes of hypotension during hemodialysis improved, and dyspnea diminished. Echocardiography showed no Pericardial Effusion and improvement of left ventricular wall motion. Pericarditis is a fatal complication in patients with end-stage renal failure and patients on maintenance hemodialysis. The second patient received the same procedure with a similar improvement of clinical symptoms. These cases suggest that thoracoscopic pericardiectomy is a safe and effective treatment of Pericardial Effusion caused by uremic pericarditis in elderly patients on hemodialysis.
Gerard Devlin - One of the best experts on this subject based on the ideXlab platform.
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primary percutaneous balloon pericardiotomy for malignant Pericardial Effusion
Catheterization and Cardiovascular Interventions, 2008Co-Authors: Neil Swanson, Intisar Mirza, Namal Wijesinghe, Gerard DevlinAbstract:Objectives: Pericardial Effusion associated with malignancy is a life-threatening complication of late-stage disease. While simple drainage is effective in relieving the symptoms, reaccumulation of Effusion may cause further symptomatic episodes, often during a period when overall patient management is focused on improving the quality of remaining life. Over a 16-year period, we have adopted a strategy of managing such patients with balloon pericardiotomy as the initial preferred treatment. The results are described and compared to alternative management strategies. Methods: A retrospective analysis of patients who presented with symptomatic, malignant Pericardial Effusion, their management, procedural complication rates, and the need for further therapy for the same condition was made. Survival, reaccumulation rates, and readmissions after the index procedure were recorded and compared. Results: Forty-three patients were treated for malignant Pericardial Effusion. Balloon pericardiotomy was the primary treatment in 27/43 patients, simple drainage in 14/43, and surgery in 2/43. Reaccumulation rates between balloon pericardiotomy and simple aspiration (7.4% vs. 14.3%, respectively, P = 0.48) and complication rates (7.4% vs. 7.1%, respectively, P = 0.98) were not statistically different. Survival following intervention was driven by the underlying pathology and was poor, with overall median survival of 56 days. Conclusions: Balloon pericardiotomy, as initial management of symptomatic malignant Pericardial Effusions, allows a definitive procedure to be performed at presentation. This can be achieved with low complication rates, similar to treatment by simple drainage. © 2008 Wiley-Liss, Inc.
Daniel A Jones - One of the best experts on this subject based on the ideXlab platform.
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percutaneous balloon pericardiotomy for recurrent malignant Pericardial Effusion
Journal of Thoracic Oncology, 2011Co-Authors: Daniel A Jones, A JainAbstract:An 82-year-old woman with stage 3 non-small cell lung cancer presented with a large Pericardial Effusion demonstrated by transthoracic echocardiography (TTE) (Figure 1, white arrow) (Supplemental Digital Content 1, http://links.lww.com/JTO/A157). She had a history of previous Pericardial Effusion treated with pericardiocentesis. She was evaluated and deemed high risk for definitive surgical treatment. Therefore, she underwent percutaneous balloon pericardiotomy, performed from a subxiphisternal approach under aseptic technique with fluoroscopic and echocardiographic guidance (Figures 2A–D) (Supplemental Digital Content 2– 4, http://links.lww.com/JTO/A158, http://links.lww.com/JTO/A160, and http://links.lww.com/ JTO/A161). Six hundred milliliters of serous fluid was aspirated, resulting in immediate symptomatic improvement. Three months later, TTE revealed a small stable Effusion with no diastolic right atrium/right ventricle/collapse. Malignant disease is a common cause of Pericardial Effusion with incidences ranging from 1 to 20% in all cancer patients.1,2 Management is challenging with recurrence rates of 13 to 50%3 after pericardiocentesis and patients often unsuitable for surgical intervention. Percutaneous balloon pericardiotomy is a simple and safe minimally invasive alternative to drain Pericardial Effusions.
