| Impact of controlled pericardial drainage on critical cardiac tamponade with acute type a aortic dissection. | |
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MedLine Citation:
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PMID: 22966000 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Cardiac tamponade is associated with fatal outcomes for patients with acute type A aortic dissection, and the presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of controlled pericardial drainage (CPD) managing critical cardiac tamponade. METHODS AND RESULTS: Between September 2003 and May 2011, 175 patients with acute type A aortic dissection were treated surgically, including 43 (24.6%) who presented with cardiac tamponade on arrival. Eighteen patients, who did not respond to intravenous volume resuscitation, underwent CPD in the emergency department. An 8F pigtail drainage catheter was inserted percutaneously, and drainage volume was controlled by means of several cycles of intermittent drainage to maintain blood pressure at ≈90 mm Hg. After CPD, all of the patients were transferred to the operating room, and immediate aortic repair was performed. Systolic blood pressure before CPD was 64.3±8.2 mm Hg and elevated significantly in all of the cases after CPD. Systolic blood pressure after CPD was 94.8±10.5 mm Hg, and increase in systolic pressure was 30.5±11.7 mm Hg. Total volume of aspirated pericardial effusion was 40.1±30.6 mL, and 10 patients required only ≤30-mL aspiration volume. All of the patients underwent aortic repair successfully. In-hospital mortality was 16.7%; however, there was no complications or mortality related to CPD. CONCLUSIONS: Preoperative pericardial drainage with control of volume is a safe and effective procedure for acute type A aortic dissection complicated by critical cardiac tamponade. In our patient population, timely controlled pericardial drainage is warranted. |
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Authors:
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Taro Hayashi; Takuro Tsukube; Teruo Yamashita; Tomonori Haraguchi; Ritsu Matsukawa; Shuichi Kozawa; Kyoichi Ogawa; Yutaka Okita |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 126 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-09-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: S97-S101 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital, 1-3-1 Wakihama-kaigandori Chuo-ku, Kobe, Japan 651-0073. t-tsukube@kobe.jrc.or.jp. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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