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J A Hutter - One of the best experts on this subject based on the ideXlab platform.

  • posterior Pericardiotomy reduces the incidence of supra ventricular arrhythmias following coronary artery bypass surgery
    European Journal of Cardio-Thoracic Surgery, 1995
    Co-Authors: A Mulay, A J Kirk, Gianni D Angelini, J D Wisheart, J A Hutter
    Abstract:

    A prospective study of 100 patients undergoing coronary artery bypass surgery was performed to demonstrate the effectiveness of a posterior Pericardiotomy in reducing the incidence of pericardial effusions and, consequently, reducing the incidence of supraventricular arrhythmias in the post-operative period. Pericardial effusion occurred in 4 of 50 patients following a posterior Pericardiotomy, whereas effusion occurred in 20 of 50 patients in whom a Pericardiotomy was not created (P < 0.0005). Supra-ventricular arrhythmias occurred in 4 patients in the Pericardiotomy group and 18 in the group treated without Pericardiotomy (P < 0.005). No complications resulted from this procedure. We conclude that Pericardiotomy is a simple, safe and effective method for reducing the incidence or pericardial effusion and thereby post-operative supra-ventricular arrhythmias.

A Jain - One of the best experts on this subject based on the ideXlab platform.

  • percutaneous balloon Pericardiotomy for recurrent malignant pericardial effusion
    Journal of Thoracic Oncology, 2011
    Co-Authors: Daniel A Jones, A Jain
    Abstract:

    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.

G R Corey - One of the best experts on this subject based on the ideXlab platform.

  • a prospective trial of subxiphoid Pericardiotomy in the diagnosis and treatment of large pericardial effusion a follow up report
    Annals of Surgery, 1993
    Co-Authors: P Van Trigt, James M Douglas, Peter K Smith, Paul Campbell, Thomas C Wall, Richard T Kenney, Christopher M Oconnor, Khalid H Sheikh, G R Corey
    Abstract:

    Objective This study was designed to determine the cause of large pericardial effusions and evaluate the efficacy of subxiphoid Pericardiotomy. Summary background data 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.

  • subxiphoid Pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy
    Chest, 1992
    Co-Authors: Paul Campbell, P Van Trigt, Thomas C Wall, Richard T Kenney, Christopher M Oconnor, Khalid H Sheikh, Joseph Kisslo, M E Baker, G R Corey
    Abstract:

    To determine the safety, diagnostic value, and clinical outcome of patients with malignancy undergoing subxiphoid Pericardiotomy for large pericardial effusions, we prospectively studied 25 consecutive patients with malignancy and new, large pericardial effusions diagnosed by echocardiography. Twenty-two of the 25 operations were done under local anesthesia, and no patient died at surgery. Pericardial fluid cytology revealed malignant cells in 11 patients (44 percent), while tumor was seen in only five (45 percent) of these 11 patients on pathologic examination. The remaining 14 patients showed no evidence of pericardial invasion with tumor. Evidence of intrathoracic disease by CT or MRI scanning, tamponade, a sanguineous pericardial fluid character, and an elevated serum and pericardial fluid lactate dehydrogenase level all were suggestive of malignant invasion of the pericardium. All 25 patients were followed at least 12 months postoperatively. Effusions recurred in three patients (12 percent), and one patient required reoperation. Overall mortality was 72 percent with a 91 percent (10 of 11) mortality for those with malignant effusions and a 57 percent (8 of 14) mortality for those with nonmalignant effusions. Diagnostically, subxiphoid Pericardiotomy has little advantage over examination of pericardial fluid alone in this group of patients. Therapeutically, however, it is a low morbidity procedure which is safe and effective in treating patients with malignancy and large pericardial effusions.

Harun Tatar - One of the best experts on this subject based on the ideXlab platform.

  • effect of posterior Pericardiotomy on postoperative supraventricular arrhythmias and late pericardial effusion posterior Pericardiotomy
    The Journal of Thoracic and Cardiovascular Surgery, 1999
    Co-Authors: Erkan Kuralay, Ertugrul Ozal, Ufuk Demirkilic, Harun Tatar
    Abstract:

    Abstract Objective: The aim of this prospective study was to evaluate the effectiveness of posterior Pericardiotomy from the point of pericardial effusion related with supraventricular tachycardia and development of delayed posterior cardiac effusions. Materials and methods: This prospective randomized study was carried out in 200 patients undergoing coronary artery bypass surgery in Gulhane Medical Academy Department of Cardiovascular Surgery between June 1996 and June 1997. Patients were divided into 2 groups; each group included 100 patients. Longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group I patients. Posterior Pericardiotomy was not done in group II. Results: Atrial fibrillation was developed in 6 patients (6%) in group I and in 34 patients (34%) in group II ( P = .0000007). Atrial flutter and other supraventricular arrhythmia prevalence was not statistically significant. Early and late pericardial effusion were developed 54% and 21%, respectively, in group II, but neither early nor late pericardial effusion were developed in group I ( P = .00001). Delayed pericardial tamponade was also significantly lower in group I (0% vs 10%; P = .001). Conclusion: Posterior Pericardiotomy is technically easy to perform and a safe and effective technique that reduces not only the prevalence of early pericardial effusion and related atrial fibrillation but also delayed posterior pericardial effusion and tamponade. (J Thorac Cardiovasc Surg 1999;118:492-5)

  • Late posterior cardiac tamponade after open heart surgery.
    The Journal of cardiovascular surgery, 1996
    Co-Authors: Ahmet Turan Yilmaz, Arslan M, Demirkliç U, Kuralay E, Ozal E, Bingöl H, Harun Tatar, Ömer Y. Öztürk
    Abstract:

    OBJECTIVE Late cardiac tamponade after open heart surgery is a relatively uncommon, but potentially serious complication. We retrospectively analyzed 14 patients who had posterior cardiac tamponade 13 to 210 days after open heart surgery. PATIENTS Between May 1988 and July 1995, 3150 adult patients underwent open heart surgery at the Gulhane Military Medical Academy. In 35 of 3150 patients (1.11%) late pericardial effusions developed, and in 14 (0.44% of 3150 consecutive open heart surgery performed on adult patients in our center) of these patients had posterior tamponade. There were moderate symptoms including fatigue, malaise, and dyspnea on exertion in all patients. The diagnosis was made by echocardiography in 13 patients, and by tomographic scanning in 1 patient. Analysis of these 14 patients revealed that all of them had hemodynamic criteria consistent with tamponade physiology on right heart catheterization with Swan-Ganz catheters. RESULTS Echocardiography guid pericardiocentesis through the left anterior axillary line was effective in decompressing of posterior cardiac tamponade in 10 of 14 patients. Three patients required operative surgical drainage after unsuccessful pericardiocentesis through subxiphoid area. Two patients who underwent surgical drainage died, and in one patient surgical Pericardiotomy had complete evacuation of posterior pericardial fluid with major complication. CONCLUSIONS 2-D echocardiography guid pericardiocentesis through left anterior axillary line was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to surgical Pericardiotomy for posterior cardiac tamponade after open heart surgery.

Yaman Zorlutuna - One of the best experts on this subject based on the ideXlab platform.

  • posterior Pericardiotomy reduces the incidence of supra ventricular arrhythmias and pericardial effusion after coronary artery bypass grafting
    European Journal of Cardio-Thoracic Surgery, 2002
    Co-Authors: Bora Farsak, Serdar Gunaydin, Hilmi Tokmakoglu, Ozer Kandemir, Cem Yorgancioglu, Yaman Zorlutuna
    Abstract:

    Objective: The aim of this prospective study was to demonstrate the effectiveness of posterior Pericardiotomy in reducing the incidence pericardial effusions and consequently reducing the related supraventricular tachyarrhythmias and development of delayed posterior cardiac effusions. Methods: This prospective randomized study was carried out in 150 patients undergoing coronary artery bypass grafting in Bayindir Hospital Department of Cardiovascular Surgery between April 2000 and October 2001. One hundred and fifty patients were divided into two groups; each group included 75 patients. A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in posterior Pericardiotomy group (group I). Posterior Pericardiotomy was not performed in conventional treatment group (group II). Results: Atrial fibrillation was developed in seven patients (9.3%) in group I and in 24 patients (32%) in group II (P , 0:001). Atrial flutter and other supraventricular tachyarrhythmia (SVT) prevalence was not statistically significant. Early pericardial effusion was developed 42.6% (32/75) and 10.6% (8/75), respectively, in group II and group I (P , 0:0001), but no late pericardial effusion developed in group I despite seven (9.3%) late pericardial effusions developing in group II (P , 0:013). Conclusion: Posterior Pericardiotomy is a simple, safe and effective technique for reducing not only the prevalence of early pericardial effusion and related atrial fibrillation but also delayed posterior pericardial effusion and tamponade. q 2002 Elsevier Science B.V. All rights reserved.