Skip to main content
Erschienen in: CardioVascular and Interventional Radiology 8/2017

23.03.2017 | Clinical Investigation

CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery

verfasst von: Nour-Eldin Abdelrehim Nour-Eldin, Mohammed Alsubhi, Tatjana Gruber-Rouh, Thomas J. Vogl, Benjamin Kaltenbach, Hazem Hamed Soliman, Wael Eman Hassan, Sherif Maher Abolyazid, Nagy N. Naguib

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery.

Materials and Methods

The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF) <50%. The preintervention ejection fraction was determined echocardiographically with value between 30 and 40%. Exclusion criteria for drainage were hemodynamically unstable patients or impaired coagulation profile (INR <1.8 or platelet count <75,000). Drains (8F–10F) were applied using Seldinger’s technique under CT guidance.

Results

Pericardiocentesis and placement of a percutaneous pericardial drain was technically successful in all patients. The mean volume of evacuated pericardial effusion was 260 ml (range 80–900 ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40–55% (mean: 45%; SD: ±5; p < 0.05). The mean percentage increase of the EF following pericardial effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p < 0.05) in comparison to the preventricular position of the catheter. Recorded complications included minimal asymptomatic pneumothorax and pneumomediastinum 2.3% (3/128) and sinus tachycardia 3.9% (5/128).

Conclusion

CT-guided drainage of postoperative pericardial effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.
Literatur
1.
Zurück zum Zitat Kim HJ, Jung SH, Kim JJ, et al. Early postoperative complications after heart transplantation in adult recipients: asan medical center experience. Korean J Thorac Cardiovasc Surg. 2013;46:426–32.CrossRefPubMedPubMedCentral Kim HJ, Jung SH, Kim JJ, et al. Early postoperative complications after heart transplantation in adult recipients: asan medical center experience. Korean J Thorac Cardiovasc Surg. 2013;46:426–32.CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Ashikhmina EA, Schaff HV, Sinak LJ, et al. Pericardial effusion after cardiac surgery: risk factors, patient profiles, and contemporary management. Ann Thorac Surg. 2010;89:112–8.CrossRefPubMed Ashikhmina EA, Schaff HV, Sinak LJ, et al. Pericardial effusion after cardiac surgery: risk factors, patient profiles, and contemporary management. Ann Thorac Surg. 2010;89:112–8.CrossRefPubMed
3.
Zurück zum Zitat Saltzman AJ, Paz YE, Rene AG, Green P, Hassanin A, Argenziano MG, et al. Comparison of surgical pericardial drainage with percutaneous catheter drainage for pericardial effusion. J Invasive Cardiol. 2012;24:590–3.PubMedPubMedCentral Saltzman AJ, Paz YE, Rene AG, Green P, Hassanin A, Argenziano MG, et al. Comparison of surgical pericardial drainage with percutaneous catheter drainage for pericardial effusion. J Invasive Cardiol. 2012;24:590–3.PubMedPubMedCentral
4.
Zurück zum Zitat Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology. 2013;267:340–56.CrossRefPubMed Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology. 2013;267:340–56.CrossRefPubMed
5.
Zurück zum Zitat Wang ZJ, Reddy GP, Gotway MB, et al. CT and MR imaging of pericardial disease. RadioGraphics. 2003;23:167–80.CrossRef Wang ZJ, Reddy GP, Gotway MB, et al. CT and MR imaging of pericardial disease. RadioGraphics. 2003;23:167–80.CrossRef
6.
Zurück zum Zitat Eichler K, Zangos S, Thalhammer A, et al. CT-guided pericardiocenteses: clinical profile, practice patterns and clinical outcome. Eur J Radiol. 2010;75:28–31.CrossRefPubMed Eichler K, Zangos S, Thalhammer A, et al. CT-guided pericardiocenteses: clinical profile, practice patterns and clinical outcome. Eur J Radiol. 2010;75:28–31.CrossRefPubMed
7.
8.
Zurück zum Zitat Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol. 2012;27(3):308–17.CrossRefPubMed Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol. 2012;27(3):308–17.CrossRefPubMed
9.
Zurück zum Zitat Ristić AD, Imazio M, Adler Y, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35(34):2279–84.CrossRefPubMed Ristić AD, Imazio M, Adler Y, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35(34):2279–84.CrossRefPubMed
10.
Zurück zum Zitat Maggiolini S, Gentile G, Farina A, et al. Safety, efficacy, and complications of pericardiocentesis by real-time echo-monitored procedure. Am J Cardiol. 2016;117(8):1369–74.CrossRefPubMed Maggiolini S, Gentile G, Farina A, et al. Safety, efficacy, and complications of pericardiocentesis by real-time echo-monitored procedure. Am J Cardiol. 2016;117(8):1369–74.CrossRefPubMed
Metadaten
Titel
CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery
verfasst von
Nour-Eldin Abdelrehim Nour-Eldin
Mohammed Alsubhi
Tatjana Gruber-Rouh
Thomas J. Vogl
Benjamin Kaltenbach
Hazem Hamed Soliman
Wael Eman Hassan
Sherif Maher Abolyazid
Nagy N. Naguib
Publikationsdatum
23.03.2017
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 8/2017
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-017-1624-2

Weitere Artikel der Ausgabe 8/2017

CardioVascular and Interventional Radiology 8/2017 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.