Pericardial-Peritoneal Window: A Novel Palliative Treatment for Malignant and Recurrent Cardiac Tamponade

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Abstract

Transdiaphragmatic approach to the pericardium through a subxiphoid incision is a safe, rapid, and effective way to obtain drainage of the pericardium fluid in patient of disseminated malignancy with recurrent cardiac tamponade. No drainage tubes are needed; pericardial fluid is absorbed by the peritoneum; there is no need for double lumen tubes for single lung ventilation and the subxiphoid incisions are small and almost painless.

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Most cited references 14

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Radiation therapy of cardiac and pericardial metastases.

Katrina Chu, Russ Carstens, W Cham … (1975)

Cardiac metastasis should be strongly suspected in the cancer patient with sudden onset of unexplained tachycardia, arrhythmia, or congestive heart failure. Conduction defects and low voltage on electrocardiographic examination and an enlarged heart shadow on the chest film are virtually confirmatory. Thirty-eight such patients were treated through anterior and posterior opposing portals and received 2,500-3,500 rads in 3-4 weeks, except for 6 lymphoma and leukemia patients who were controlled with lower doses (1,500-2,000 rads in 11/2-2 weeks). Primary sites and duration of improvement were as follows: breast (11/16 patients): 2-36 months; lung (2/7 patients): 1-9 months; lymphoma and leukemia (6/7 patients): 2-4 months; others (4/8 patients): 1-4 months. Overall, the clinical improvement rate was 60%, with durations of 12 to 36 months.

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Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course.

J R Pluth, H Schaff, G Danielson … (1985)

Surgical drainage for effusive pericardial disease is usually accompanied by pericardial resection to obtain tissue for analysis and to lessen the chance of recurrent effusion or late constriction. The purpose of this study was to determine the relationship between the extent of resection and the development of late complications. From 1960 through 1983, 145 patients with pure pericardial effusive disease underwent operative drainage. The effusions were malignant in 72 patients (49.7%) and benign in 73 (50.3%). The patients were divided into three groups according to the extent of resection: complete in 72 patients (49.7%), partial in 36 (24.8%), and window in 37 (25.5%). The 30 day mortality was 19.4% for patients with malignant effusions and 5.5% for those with benign effusions (p less than 0.05). All survivors had immediate improvement in symptoms. The actuarial 1 year survival rate was 23.4% (mean 4.2 months) for patients with malignant disease and 85.6% for patients with idiopathic effusions (p less than 0.001). Survival was not influenced by the extent of resection. Fifteen patients (10.3%) had late constriction or recurrent effusion. Six of these required reoperation, all after having had a window procedure. Actuarial probability of reoperation or late complication was greater with window procedures than other resections, both for all patients (p = 0.0001) and for those with benign disease (p = 0.0001). Transthoracic complete pericardiectomy is the procedure of choice for effusive pericardial disease. Subxiphoid drainage has immediate advantages for selected patients but has a statistically greater chance of late complications.

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Tetracycline sclerosis in the management of malignant pericardial effusion.

J Ginsberg, Greg W. Evans, Brandon Scott … (1985)

Twenty-two patients with malignant pericardial effusion were seen at the Toronto General Hospital between 1979 and 1984. Under ECG monitoring, an indwelling Kifa catheter was inserted into the pericardial sac and then connected to a Hemovac system and allowed to drain for 12 to 24 hours. Xylocaine hydrochloride, 100 mg, was first instilled intrapericardially, followed by tetracycline hydrochloride, 500 to 1,000 mg, dissolved in 20 mL normal saline. The catheter was clamped for one to two hours and then allowed to drain into the Hemovac. This procedure was repeated every 24 to 48 hours until the net drainage was less than 25 mL/24 hours. Nine men and 13 women were treated (median age, 55 years). The primary malignancy included lung in 15 patients, breast in two patients, and carcinoma of the stomach, ovary, pleural mesothelioma, chronic granulocytic leukemia, and adenocarcinoma of unknown primary in one patient each. Twenty patients received one to five instillations of tetracycline. In one patient the catheter could not be inserted into the pericardial sac, and in one patient the catheter clotted before tetracycline instillation. Minor complications included transient arrhythmia in two patients, postinjection pain in four patients, and self-limited temperature elevation greater than 38.5 degrees C in two patients. fifteen patients had good control of their malignant pericardial effusion for more than 30 days (median survival, 160 days; range, 38 to 275 days). Three patients died before 30 days without evidence of effusion, and no patient surviving longer than 30 days developed recurrent effusion or pericardial constriction. Intrapericardial tetracycline instillation is a safe and efficacious treatment for malignant pericardial effusion and should be considered the first treatment modality in this situation.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Palliat Care

Journal ID (iso-abbrev): Indian J Palliat Care

Journal ID (publisher-id): IJPC

Title: Indian Journal of Palliative Care

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0973-1075

ISSN (Electronic): 1998-3735

Publication date (Print): May-Aug 2013

Volume: 19

Issue: 2

Pages: 116-118

Affiliations

[1]Department of Surgical Oncology, Grecian Cancer and Superspeciality Hospital, Mohali, Punjab, India

[1 ]Department of Cardiothoracic Surgery, Grecian Cancer and Superspeciality Hospital, Mohali, Punjab, India

[2 ]Department of Radiation Oncology, Grecian Cancer and Superspeciality Hospital, Mohali, Punjab, India

[3 ]Department of Cardiology, Grecian Cancer and Superspeciality Hospital, Mohali, Punjab, India

[4 ]Department of Anaesthesia, Grecian Cancer and Superspeciality Hospital, Mohali, Punjab, India

Author notes

Address for correspondence: Dr. Ashwin Anand Kallianpur; E-mail: docash04@ 123456yahoo.com

Article

Publisher ID: IJPC-19-116

DOI: 10.4103/0973-1075.116710

PMC ID: 3775022

PubMed ID: 24049355

SO-VID: 40024fbc-6bc4-4374-8e6f-7a46b793e27b

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pericardial-Peritoneal Window: A Novel Palliative Treatment for Malignant and Recurrent Cardiac Tamponade

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Cardiovascular Innovations and Applications

Most cited references 14

Radiation therapy of cardiac and pericardial metastases.

Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course.

Tetracycline sclerosis in the management of malignant pericardial effusion.

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