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CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery

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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.

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe – University Hospital, Frankfurt am Main, Germany

    Nour-Eldin Abdelrehim Nour-Eldin, Mohammed Alsubhi, Tatjana Gruber-Rouh, Thomas J. Vogl, Benjamin Kaltenbach & Nagy N. Naguib

  2. Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt

    Nour-Eldin Abdelrehim Nour-Eldin, Hazem Hamed Soliman, Wael Eman Hassan & Sherif Maher Abolyazid

  3. Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria, Egypt

    Nagy N. Naguib

Authors
  1. Nour-Eldin Abdelrehim Nour-Eldin
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  2. Mohammed Alsubhi
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  3. Tatjana Gruber-Rouh
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  4. Thomas J. Vogl
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  5. Benjamin Kaltenbach
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  6. Hazem Hamed Soliman
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  7. Wael Eman Hassan
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  8. Sherif Maher Abolyazid
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  9. Nagy N. Naguib
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Corresponding author

Correspondence to Nour-Eldin Abdelrehim Nour-Eldin.

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The authors state the fact that this article is not under consideration for publication elsewhere or any part of it has been sent elsewhere, and there is no conflict of interest. The Publication is approved by all authors. There are no conflicts of interest. We also agree the regulations of copyright of the publisher.

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Nour-Eldin, NE.A., Alsubhi, M., Gruber-Rouh, T. et al. CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery. Cardiovasc Intervent Radiol 40, 1223–1228 (2017). https://doi.org/10.1007/s00270-017-1624-2

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  • DOI: https://doi.org/10.1007/s00270-017-1624-2

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