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J Thorac Cardiovasc Surg 1997;113:427-428
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Purulent pericarditis

W.-B. Winkler, MD, R. Karnik, MD, J. Slany, MD

Department of Internal Medicine II
Krankenanstalt Rudolfstiftung
A-1030 Wien, Austria

To the Editor:

We are very interested in the article by Mann-Segal and associates,Go 1 concerning successful treatment of purulent pericarditis by irrigation of fibrinolytics, and we fully support this technique. WeGo 2 previously reported the use of intrapericardial urokinase to dissolve pericardial fibrin layers in three patients, and the drug was well tolerated in these patients. Mann-Segal did not mention laboratory tests in his report; in our patients no changes occurred either in hemodynamic or in coagulation parameters during the period of intrapericardial fibrinolytic therapy. Our safety measures included echocardiography during instillation to detect iatrogenic right heart compression and warming of the irrigation fluid to prevent arrhythmias.

We used urokinase for the lysis of pericardial fibrin deposits because urokinase has equal fibrinolytic potency but less antigenic potency than streptokinase.Go 3 The efficacy of urokinase in dissolving extravascular fibrin has been demonstrated especially in the pleural cavity by intrapleural administration.Go Go 4,5

Fibrinolytic pericardial irrigation with urokinase as well as streptokinase seems to be a promising treatment of exudative fibrinous pericarditis, which can prevent constrictive pericarditis without surgical intervention. The ideal dose and treatment regimen, however, remain to be defined.

12/8/77668

References

  1. Mann-Segal DDM, Shanahan EA, Jones B, Ramasamy D. Purulent pericarditis: rediscovery of an old remedy. J Thorasc Cardiovasc Surg 1996;111:487-8.[Free Full Text]
  2. Winkler WB, Karnik R, Slany J. Treatment of exudative fibrinous pericarditis with intrapericardial urokinase. Lancet 1994;344:1541-42.[Medline]
  3. Collen D, Verstraete M. Pharmacology of thrombolytic agents. In: Schlant RC, Alexander RW, O'Rourke RA, Roberts R, Sonnenblick EH, editors: Hurst's the heart. New York: McGraw-Hill, 1994:1327-37.
  4. Moulton JS, Moore PT, Mencini RA. Treatment of loculated pleural effusions with transcatheter intracavitary urokinase. Am J Roentgenol 1989;153:941-45.[Abstract/Free Full Text]
  5. Couser JI, Berley J, Timm EG. Intrapleural urokinase for loculated effusion. Chest 1992;101:1467-9.




This Article
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