Pericardial windows have limited diagnostic success

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RESEARCH ARTICLE

Open Access

Pericardial windows have limited diagnostic success Lindsay Volk, Hirohisa Ikegami, Leonard Y. Lee and Anthony Lemaire*

Abstract Background: Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures. Methods: We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival. Results: A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients. Conclusion: Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit. Keywords: Effusion, Tamponade, Drainage

Background A pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, postoperative cardiac surgery patients, or patients who have certain infectious, benign or malignant diseases. They are often diagnosed either as incidental findings or when its related to systemic or cardiac disease [1]. The clinical spectrum of patients with pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade [2, 3]. Management is guided by the hemodynamic impact, size, presence of inflammation (i.e. pericarditis), and the etiology. Drainage of the PE is required for cardiac tamponade, symptomatic moderate to large * Correspondence: [email protected] Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA

pericardial effusions and when a bacterial or neoplastic etiology is suspected [1]. Surgical pericardial drainage procedures, “Pericardial Windows”, are often requested for both diagnostic and therapeutic