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Echocardiographic Screening for Postoperative Pericardial Effusion in Children

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Abstract

Pericardial effusion (PE) after cardiac surgery can be life threatening without timely detection, and the optimal screening method is unknown. We sought to evaluate the role of a surveillance echocardiogram on postoperative day 10 (± 2), determine the incidence of postoperative PE, and identify risk factors. We conducted a retrospective cohort study including all pediatric patients who underwent open heart surgery at a single institution over a 7-month period. To identify risk factors for PE, medical records of patients with PE detected within 6 weeks after surgery (cases) were compared with patients without PE (controls). Of 203 patients, 52 (26%) had PE within 6 weeks; 42 (81%) were trivial-small and 10 (19%) were moderate-large. Twenty-nine (56%) were first detected within 7 days post-operatively, including all cases developing cardiac tamponade (n = 3). An echocardiogram was done 10 (± 2) days post-operatively in 41/52 cases, of which 12/41 (29%) did not have a PE at this time, 24/41 (59%) had a trivial-small PE, and 5/41(12%) had a moderate-large PE; 2 of the latter had no prior detected PE. Closure of an atrial septal defect had the highest incidence of PE (42%). PE cases were associated with postoperative nasopharyngeal detection of a respiratory virus (OR 3.8, p = 0.03). In conclusion, the majority of PE cases were detected within 7 days post-operatively, including all cases subsequently developing cardiac tamponade. Day 10 echocardiography infrequently detected a moderate or large effusion that had previously gone undiagnosed. A positive perioperative nasopharyngeal aspirate for a respiratory virus was associated with postoperative PE.

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Data is available upon request.

References

  1. Weitzmam LBTW, Kronzon I, Cohen ML, Glassman E, Spencer FC (1984) The incidence and natural history of pericardial effusion after cardiac surgery. Echocardiogr Study Circ 69:506–511

    Google Scholar 

  2. Clapp SK, Garson A Jr, Gutgesell HP, Cooley DA, McNamara DG (1980) Postoperative pericardial effusion and its relation to postpericardiotomy syndrome. Pediatrics 66(4):585–588

    CAS  PubMed  Google Scholar 

  3. Stevenson LW, Child JS, Laks H, Kern L (1984) Incidence and significance of early pericardial effusions after cardiac surgery. Am J Cardiol 54(7):848–851

    Article  CAS  Google Scholar 

  4. Beland MJ, Paquet M, Gibbons JE, Tchervenkov CI, Dobell AR (1990) Pericardial effusion after cardiac surgery in children and effects of aspirin for prevention. Am J Cardiol 65(18):1238–1241

    Article  CAS  Google Scholar 

  5. Pastorek JS, Allen HD, Davis JT (1994) Current outcomes of surgical closure of secundum atrial septal defect. Am J Cardiol 74(1):75–77

    Article  CAS  Google Scholar 

  6. Pepi M, Muratori M, Barbier P et al (1994) Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences. Heart 72(4):327–331

    Article  CAS  Google Scholar 

  7. Prabhu AS, Ross RD, Heinert MR, Walters HL, Hakimi M (1996) Decreased incidence of postoperative pericardial effusions after cardiac surgery for congenital heart disease. Am J Cardiol 77(9):774–6

    Article  CAS  Google Scholar 

  8. Yip AS, Chau EM, Chow WH, Kwok OH, Cheung KL (1997) Pericardial effusion in adults undergoing surgical repair of atrial septal defect. Am J Cardiol 79(12):1706–1708

    Article  CAS  Google Scholar 

  9. Atik E, Ikari NM, Martins TC, Barbero-Marcial M (2002) Fontan operation and the cavopulmonary technique: immediate and late results according to the presence of atrial fenestration. Arq Bras Cardiol 78(2):162–166

    PubMed  Google Scholar 

  10. Baskett RJF, Tancock E, Ross DB (2003) The gold standard for atrial septal defect closure: current surgical results, with an emphasis on morbidity. Pediatr Cardiol 24(5):444–447

    Article  CAS  Google Scholar 

  11. Cheung EWY, Ho SA, Tang KKY, Chau AKT, Chiu CSW, Cheung YF (2003) Pericardial effusion after open heart surgery for congenital heart disease. Heart 89(7):780–783

    Article  CAS  Google Scholar 

  12. Gill PJ, Forbes K, Coe JY (2009) The effect of short-term prophylactic acetylsalicylic acid on the incidence of postpericardiotomy syndrome after surgical closure of atrial septal defects. Pediatr Cardiol 30(8):1061–1067. https://doi.org/10.1007/s00246-009-9495-1

    Article  PubMed  Google Scholar 

  13. Adrichem R, Le Cessie S, Hazekamp MG et al (2019) Risk of clinically relevant pericardial effusion after pediatric cardiac surgery. Pediatr Cardiol 40(3):585–594. https://doi.org/10.1007/s00246-018-2031-4

    Article  PubMed  Google Scholar 

  14. Tsang TS, Barnes ME, Hayes SN et al (1999) 1979 Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: mayo clinic experience. Chest 116(2):322–31

    Article  CAS  Google Scholar 

  15. Khan NK, Jarvela KM, Loisa EL, Sutinen JA, Laurikka JO, Khan JA (2017) Incidence, presentation and risk factors of late postoperative pericardial effusions requiring invasive treatment after cardiac surgery. Interact Cardiovasc Thorac Surg 24(6):835–840. https://doi.org/10.1093/icvts/ivx011

    Article  PubMed  Google Scholar 

  16. Ashikhmina EA, Schaff HV, Sinak LJ et al (2010) Pericardial effusion after cardiac surgery: risk factors, patient profiles, and contemporary management. Ann Thorac Surg 89(1):112–118. https://doi.org/10.1016/j.athoracsur.2009.09.026

    Article  PubMed  Google Scholar 

  17. Shoiab I, Danford DA, Li L, Abdullah I, Hammel JM, Kutty S (2015) Predischarge transthoracic echocardiography after surgery for congenital heart disease: a routine with a reason? J Am Soc Echocardiogr 28(9):1030–1035. https://doi.org/10.1016/j.echo.2015.04.009

    Article  PubMed  Google Scholar 

  18. Cantinotti M, Spadoni I, Assanta N et al (2014) Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: a critical review with a special emphasis on paediatric age. J Cardiovasc Med 15(12):847–854. https://doi.org/10.2459/JCM.0b013e328362c5b5

    Article  Google Scholar 

  19. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR (2002) Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg 74(4):1148–1153

    Article  Google Scholar 

  20. Bocsi J, Hambsch J, Osmancik P, Schneider P, Valet G, Tarnok A (2002) Preoperative prediction of pediatric patients with effusions and edema following cardiopulmonary bypass surgery by serological and routine laboratory data. Crit Care 6(3):226–233

    Article  Google Scholar 

  21. Hauptman PJ, Couper GS, Aranki SF, Kartashov A, Mudge GH Jr, Loh E (1994) Pericardial effusions after cardiac transplantation. J Am Coll Cardiol 23(7):1625–1629

    Article  CAS  Google Scholar 

  22. Malouf JF, Alam S, Gharzeddine W, Stefadouros MA (1993) The role of anticoagulation in the development of pericardial effusion and late tamponade after cardiac surgery. Eur Heart J 14(11):1451–7

    Article  CAS  Google Scholar 

  23. Angelini GD, Penny WJ, el-Ghamary F, et al (1987) The incidence and significance of early pericardial effusion after open heart surgery. Eur J Cardio-Thorac Surg 1(3):165–168

    Article  CAS  Google Scholar 

  24. Elias MD, Glatz AC, O’Connor MJ et al (2017) Prevalence and risk factors for pericardial effusions requiring readmission after pediatric cardiac surgery. Pediatr Cardiol 38(3):484–494. https://doi.org/10.1007/s00246-016-1540-2

    Article  PubMed  Google Scholar 

  25. Kirkpatrick E, Hurwitz R, Brown J (2008) A single center’s experience with the Ross procedure in pediatrics. Pediatr Cardiol 29(5):894–900. https://doi.org/10.1007/s00246-008-9224-1

    Article  PubMed  Google Scholar 

  26. Bortolotti U, Livi U, Frugoni C et al (1981) Delayed cardiac tamponade following open heart surgery. Analysis of 12 patients. Thorac Cardiovasc Surg 29(4):233–236

    Article  CAS  Google Scholar 

  27. Dziadulewicz L, Shannon-Stone M (1995) Postpericardiotomy syndrome: a complication of cardiac surgery. AACN Clin Issues 6(3):464–470

    CAS  PubMed  Google Scholar 

  28. Engle MA, Klein AA, Hepner S, Ehlers KH (1976) The postpericardiotomy and similar syndromes. Cardiovasc Clin 7(3):211–217

    CAS  PubMed  Google Scholar 

  29. Bocsi J, Richter M, Hambsch J et al (2006) Transient Th1/Th2 disbalance indicates postoperative effusions and edema after cardiopulmonary bypass in children. Cytom Part A 69(3):165–168

    Article  Google Scholar 

  30. Tarnok A, Bocsi J, Pipek M et al (2001) Preoperative prediction of postoperative edema and effusion in pediatric cardiac surgery by altered antigen expression patterns on granulocytes and monocytes. Cytometry 46(4):247–253

    Article  CAS  Google Scholar 

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Funding

Dr. Galante was funded by a Women and Children’s Health Research Institute Trainee Grant, and by an American Academy of Pediatrics Resident Research Grant.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, 8440-112thSt. NW, Edmonton, AB, T6G 2B7, Canada

    Gary J. Galante, Ivan M. Rebeyka & Andrew S. Mackie

  2. Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada

    Daryl I. Schantz

  3. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Kimberley A. Myers

  4. Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada

    Charissa R. Pockett

  5. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Ivan M. Rebeyka

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  1. Gary J. Galante
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  2. Daryl I. Schantz
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  3. Kimberley A. Myers
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  4. Charissa R. Pockett
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  5. Ivan M. Rebeyka
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  6. Andrew S. Mackie
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Correspondence to Andrew S. Mackie.

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All the authors declare that they have no conflict of interest.

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Health Research Ethics Board, University of Alberta (Pro00022477_REN5).

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Galante, G.J., Schantz, D.I., Myers, K.A. et al. Echocardiographic Screening for Postoperative Pericardial Effusion in Children. Pediatr Cardiol 42, 1531–1538 (2021). https://doi.org/10.1007/s00246-021-02637-7

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  • DOI: https://doi.org/10.1007/s00246-021-02637-7

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