Diagnosis and Management of Postoperative Pericardial Effusions and Late Cardiac Tamponade Following Open-Heart Surgery

Ann Thorac Surg. 1981 Jun;31(6):512-9. doi: 10.1016/s0003-4975(10)61340-9.

Abstract

The clinical and laboratory findings of 28 patients identified as having late pericardial effusions were examined. Eleven of these patients were asymptomatic; 9 patients had moderate symptoms including fatigue, malaise, weight gain, and dyspnea on exertion, and 8 patients with similar symptoms had evidence of cardiac tamponade. Ten patients underwent right heart catheterization in the intensive care unit; normal hemodynamics were confirmed in 4 and cardiac tamponade in 6 patients. Pericardiocentesis was effective in decompressing cardiac tamponade in 7 of 8 patients. One patient required operative subxiphoid drainage after unsuccessful pericardiocentesis. In addition, 5 patients with moderate clinical symptoms and pericardial effusions, who did not have cardiac tamponade, underwent pericardiocentesis because of a need for chronic anticoagulant therapy. The remaining patients were managed successfully by observation, discontinuation of warfarin when possible, fluid restriction, and diuretic therapy. All but 1 patient was symptomatically improved. A diagnostic and therapeutic schema is presented as an aid to early recognition of this troublesome and potentially lethal complication.

MeSH terms

  • Adult
  • Aged
  • Cardiac Catheterization
  • Cardiac Surgical Procedures*
  • Cardiac Tamponade / diagnosis*
  • Cardiac Tamponade / therapy
  • Female
  • Humans
  • Kidney Diseases / pathology
  • Male
  • Middle Aged
  • Pericardial Effusion / diagnosis*
  • Pericardial Effusion / therapy
  • Postoperative Complications / diagnosis
  • Postoperative Complications / therapy