Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo- guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998

Teresa S M Tsang, Marion E. Barnes, Sharonne N. Hayes, William K. Freeman, Joseph A. Dearani, Sara L. Osborn Butler, James B. Seward

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122 Citations (Scopus)

Abstract

Study objectives: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. Design: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. Results: Use of anticoagulant therapy was considered a significant contributing factor in 86% and 65% of early effusions (≤ 7 days after surgery) and late effusions (> 7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34%). Common presenting symptoms included malaise (90%), dyspnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46% and 50%, respectively. Conclusions: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.

Original languageEnglish (US)
Pages (from-to)322-331
Number of pages10
JournalChest
Volume116
Issue number2
DOIs
StatePublished - 1999

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Pericardiocentesis
Pericardial Effusion
Ambulatory Surgical Procedures
Registries
Echocardiography
Drainage
Postpericardiotomy Syndrome
Catheters
Recurrence
Chest Tubes
Venous Pressure
Lacerations
Transesophageal Echocardiography
Pneumothorax
Chest Pain
Tachycardia
Dyspnea
Hypotension
Anticoagulants
Pulse

Keywords

  • Cardiac tamponade
  • Echo-guided pericardiocentesis
  • Postoperative pericardial effusions
  • Two-dimensional echocardiography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo- guided pericardiocentesis for management : Mayo Clinic experience, 1979-1998. / Tsang, Teresa S M; Barnes, Marion E.; Hayes, Sharonne N.; Freeman, William K.; Dearani, Joseph A.; Osborn Butler, Sara L.; Seward, James B.

In: Chest, Vol. 116, No. 2, 1999, p. 322-331.

Research output: Contribution to journalArticle

Tsang, Teresa S M ; Barnes, Marion E. ; Hayes, Sharonne N. ; Freeman, William K. ; Dearani, Joseph A. ; Osborn Butler, Sara L. ; Seward, James B. / Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo- guided pericardiocentesis for management : Mayo Clinic experience, 1979-1998. In: Chest. 1999 ; Vol. 116, No. 2. pp. 322-331.
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abstract = "Study objectives: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. Design: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. Results: Use of anticoagulant therapy was considered a significant contributing factor in 86{\%} and 65{\%} of early effusions (≤ 7 days after surgery) and late effusions (> 7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34{\%}). Common presenting symptoms included malaise (90{\%}), dyspnea (65{\%}), and chest pain (33{\%}). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53{\%}, 40{\%}, 39{\%}, 27{\%}, and 17{\%} of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97{\%} of all cases and in 96{\%} of all loculated effusions. Major complications (2{\%}), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46{\%} and 50{\%}, respectively. Conclusions: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.",
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T1 - Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo- guided pericardiocentesis for management

T2 - Mayo Clinic experience, 1979-1998

AU - Tsang, Teresa S M

AU - Barnes, Marion E.

AU - Hayes, Sharonne N.

AU - Freeman, William K.

AU - Dearani, Joseph A.

AU - Osborn Butler, Sara L.

AU - Seward, James B.

PY - 1999

Y1 - 1999

N2 - Study objectives: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. Design: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. Results: Use of anticoagulant therapy was considered a significant contributing factor in 86% and 65% of early effusions (≤ 7 days after surgery) and late effusions (> 7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34%). Common presenting symptoms included malaise (90%), dyspnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46% and 50%, respectively. Conclusions: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.

AB - Study objectives: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. Design: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. Results: Use of anticoagulant therapy was considered a significant contributing factor in 86% and 65% of early effusions (≤ 7 days after surgery) and late effusions (> 7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34%). Common presenting symptoms included malaise (90%), dyspnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46% and 50%, respectively. Conclusions: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.

KW - Cardiac tamponade

KW - Echo-guided pericardiocentesis

KW - Postoperative pericardial effusions

KW - Two-dimensional echocardiography

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