Document Detail


Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.
MedLine Citation:
PMID:  7833189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the incidence, characteristics, and haemodynamic consequences of pericardial effusion after cardiac surgery. DESIGN: Clinical, echocardiographic, and Doppler evaluations before and 8 days after cardiac surgery; with echocardiographic and Doppler follow up of patients with moderate or large pericardial effusion after operation. SETTING: Patients undergoing cardiac surgery at a tertiary centre. PATIENTS: 803 consecutive patients who had coronary artery bypass grafting (430), valve replacement (330), and other types of surgery (43). 23 were excluded because of early reoperation. MAIN OUTCOME MEASURES: Size and site of pericardial effusion evaluated by cross sectional echocardiography and signs of cardiac tamponade detected by ultrasound (right atrial and ventricular diastolic collapse, left ventricular diastolic collapse, distension of the inferior vena cava), and Doppler echocardiography (inspiratory decrease of aortic and mitral flow velocities). RESULTS: Pericardial effusion was detected in 498 (64%) of 780 patients and was more often associated with coronary artery bypass grafting than with valve replacement or other types of surgery; it was small in 68.4%, moderate in 29.8%, and large in 1.6%. Loculated effusions (57.8%) were more frequent than diffuse ones (42.2%). The size and site of effusion were related to the type of surgery. None of the small pericardial effusions increased in size; the amount of fluid decreased within a month in most patients with moderate effusion and in a few (7 patients) developed into a large effusion and cardiac tamponade. 15 individuals (1.9%) had cardiac tamponade; this event was significantly more common after valve replacement (12 patients) than after coronary artery bypass grafting (2 patients) or other types of surgery (1 patient after pulmonary embolectomy). In patients with cardiac tamponade aortic and mitral flow velocities invariably decreased during inspiration; the echocardiographic signs were less reliable. CONCLUSIONS: Pericardial effusion after cardiac surgery is common and its size and site are related to the type of surgery. Cardiac tamponade is rare and is more common in patients receiving oral anticoagulants. Echo-Doppler imaging is useful for the evaluation of pericardial fluid accumulations after cardiac surgery. It can identify effusions that herald cardiac tamponade.
Authors:
M Pepi; M Muratori; P Barbier; E Doria; V Arena; M Berti; F Celeste; M Guazzi; G Tamborini
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  72     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1994 Oct 
Date Detail:
Created Date:  1995-03-01     Completed Date:  1995-03-01     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  327-31     Citation Subset:  AIM; IM    
Affiliation:
Istituto di Cardiologia, Universit? degli Studi, Fondazione I Monzino IRCCS, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures* / methods
Cardiac Tamponade / ultrasonography
Echocardiography
Echocardiography, Doppler, Pulsed
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Pericardial Effusion / etiology*,  pathology,  ultrasonography
Postoperative Complications / ultrasonography*
Prospective Studies
Comments/Corrections

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