Techniques and Outcomes of Two Modes of Pericardial Drainage

Abstract

The techniques and outcomes of two modes of pericardial drainage, percutaneous pericardiocentesis and surgical pericardiotomy, were analyzed. Percutaneous pericardiocentesis was performed using the Seldinger technique. The puncture site was determined by selected criteria. Surgical pericardiotomy was performed mainly through the subxiphoid route. There were 20 pericardiocenteses and 27 pericardiotomies performed in 39 patients; 19 pericardiocenteses were successful with no complications noted, all 27 pericardiotomies were successful with only minor complications. Bloodstained fluid was found in 27 of the 38 samples of drainage (71%). Cytology for malignancy was positive in 21% and culture for tuberculosis was positive in 1 case. Biopsies improved the diagnostic yield of either disease from 18% to 38%. Malignancy was the most common cause of effusion (41%), followed by uremia. No secondary causes were found in uremic patients. The causes in 7 patients (18%) were not identified. During the study period, 16 patients died, including 1 soon after surgical drainage. Both techniques were considered to be safe and effective. In view of a case of sudden death soon after surgical drainage, it is recommended that patients with severe tamponade should have controlled percutaneous drainage.