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J Thorac Cardiovasc Surg 1996;111:489
© 1996 Mosby, Inc.

Letters to the Editor

Subxiphoid drainage for pericardial tamponade

Lister Hospital
94, Kanagasabai nagar
Chidambaram 608 001, India

To the Editor:

We fully concur with Dr. Moores and his associates ¹ in the policy of subxiphoid drainage for pericardial tamponade as a treatment option because it entails minimal anesthesia in a sick patient and is easily performed. We wish to share our experience.

We performed partial pericardiectomy and drainage of pus through an anterolateral thoracotomy in a young patient. The patient was in good hemodynamic condition with normal hepatic, renal, and pulmonary function. Her only symptoms were high fever and precordial pain. The operation was performed with the use of general anesthesia. A large collection of pus was found, with moderate tamponade, and no intraoperative problems occurred. Postoperatively, however, low cardiac output progressively developed. She died within 6 hours despite inotropic support and resuscitative measures.

Similarly, another young patient with chronic pericardial effusion and tamponade who underwent subxiphoid tube pericardiostomy under local anesthesia had low cardiac output, but it was possible to resuscitate him with inotropic support.

Neither of these patients had any underlying cardiac problem. The question is, why should low output develop after pericardial decompression in young patients with normal hemodynamic status? We presume that sudden pericardial decompression is the cause for this phenomenon. The same may have been the cause for the mortality in the published series by Moores and colleagues.

We fully agree that subxiphoid tube drainage is the best for pericardial tamponade. In chronic effusion we advocate gradual decompression of the effusion by clamping the tube and gradually releasing it.

References

1. Moores DWO, Allen KB, Faber LP, et al. Subxiphoid pericardial drainage for pericardial tamponade. J THORAC CARDIOVASC SURG1995;109:546-52.12/8/68917
   

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This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Neelakandan, B. Articles by Kanthimathi, R. Search for Related Content PubMed PubMed Citation Articles by Neelakandan, B. Articles by Kanthimathi, R.