Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Campbell, PT; Van Trigt, P; Wall, TC; Kenney, RT; O'Connor, CM; Sheikh, KH; Kisslo, JA; Baker, ME; Corey, GR

Published Date

  • April 1992

Published In

Volume / Issue

  • 101 / 4

Start / End Page

  • 938 - 943

PubMed ID

  • 1555467

International Standard Serial Number (ISSN)

  • 0012-3692

Digital Object Identifier (DOI)

  • 10.1378/chest.101.4.938


  • eng

Conference Location

  • United States