Our Summary

This research paper is about a condition called pericardial effusion, which is when there is excess fluid around the heart. This often happens in people with cancer. The aim of treating this condition is to ease symptoms, avoid repeating treatments, and help the patient function as best they can.

The first step in treatment is usually a procedure called pericardiocentesis, which involves removing the excess fluid. However, in 30-60% of cases, the fluid builds up again. If this happens, doctors will do the procedure again if the patient’s life expectancy is short. If the patient has a longer life expectancy, a type of surgery that drains the fluid is more effective and has a lower chance of the fluid coming back.

The paper also discusses an older method that involves adding a substance to the fluid to make it thicker and less likely to build up again. However, this method can cause pain and other complications and is no longer widely used.

Finally, the paper mentions that the choice of surgical method depends on where the fluid is and the patient’s overall health status. Two methods, one that involves a small cut below the breastbone and another that uses a scope, have similar results. A more invasive surgery called thoracotomy is not recommended because it does not improve results and can lead to more complications.

FAQs

  1. What is the first intervention for pericardial effusion and what are its recurrence rates?
  2. What are the effects of using sclerosing agents in the treatment of pericardial effusion?
  3. What factors influence the choice of surgical approach for treating pericardial effusion?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is that surgical drainage offers the lowest recurrence rate for patients with a longer life expectancy. The surgical approach will be based on the location of the effusion and the patient’s clinical condition. It is important to discuss the various surgical approaches with your doctor to determine the best option for you.

Suitable For

Patients who are typically recommended pericardiectomy include those with recurrent pericardial effusion, especially in cases where pericardiocentesis has high recurrence rates and extended pericardial drainage has not been successful. Patients with longer life expectancy and symptomatic pericardial disease may benefit from surgical drainage to minimize recurrence and restore functional status. The choice of surgical approach should be based on effusion location and clinical condition, with subxiphoid and thoracoscopic approaches offering similar outcomes. Patients with underlying malignancy and short median survival times may not benefit as much from pericardiectomy.

Timeline

Before pericardiectomy:

  1. Patient may present with symptoms such as chest pain, shortness of breath, and fatigue.
  2. Diagnostic tests such as echocardiography and computed tomography may be performed to confirm the presence of pericardial effusion.
  3. Pericardiocentesis may be performed to drain the fluid around the heart and provide temporary relief of symptoms.
  4. If there is recurrence of pericardial effusion, repeat pericardiocentesis or extended pericardial drainage may be considered.
  5. Surgical drainage may be recommended for patients with longer life expectancy and high recurrence rates.

After pericardiectomy:

  1. Pericardiectomy is performed to remove the pericardium, the sac surrounding the heart, in order to prevent recurrent pericardial effusion.
  2. Patients may experience improvement in symptoms such as chest pain and shortness of breath after the procedure.
  3. Recovery time after pericardiectomy may vary depending on the surgical approach used and the patient’s overall health.
  4. Regular follow-up appointments and imaging tests may be needed to monitor for any recurrence of pericardial effusion.
  5. Overall, pericardiectomy can help improve quality of life for patients with recurrent pericardial effusion.

What to Ask Your Doctor

  1. What are the potential risks and benefits of a pericardiectomy procedure for my specific case?
  2. How long is the recovery period after a pericardiectomy, and what can I expect during this time?
  3. Are there any alternative treatments or less invasive procedures that could be considered before proceeding with a pericardiectomy?
  4. What is the success rate of pericardiectomy in relieving symptoms and preventing recurrence of pericardial effusion?
  5. How experienced are you in performing pericardiectomy procedures, and what is your success rate?
  6. What are the potential complications or side effects of a pericardiectomy, and how are they typically managed?
  7. Will I need any follow-up appointments or additional treatments after the pericardiectomy procedure?
  8. How will a pericardiectomy impact my overall quality of life and ability to function on a daily basis?
  9. What can I do to prepare for a pericardiectomy procedure, both physically and mentally?
  10. Are there any specific lifestyle changes or precautions I should take after undergoing a pericardiectomy to prevent future complications?

Reference

Authors: Schusler R, Meyerson SL. Journal: Curr Cardiol Rep. 2018 Aug 20;20(10):92. doi: 10.1007/s11886-018-1040-5. PMID: 30128844