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Ann Thorac Surg 1977;23:545-549
© 1977 The Society of Thoracic Surgeons

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Articles

Subxiphoid Pericardial Window in Patients with Suspected Traumatic Pericardial Tamponade

From the Division of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio and the Audie L. Murphy Veterans Administration Hospital, San Antonio, TX

^* Address reprint requests to Dr. Arom, Division of Cardiothoracic Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284

The technique, indications, and results of subxiphoid pericardial window in penetrating chest wounds with suspected traumatic pericardial tamponade are reported.

The classic signs of pericardial tamponade (elevated central venous pressure, muffled heart sounds, and paradoxical pulse) are unreliable in an emergency situation. Chest roentgenograms and electrocardiograms are of little diagnostic value. Pericar-dicentesis was either falsely positive or negative in 50% of our patients. Therefore, unexplainedhigh central venous pressure and hypotension were considered to be pericardial tamponade until disproved by the results of a subxiphoid pericardial window.

There were 4 negative and 46 positive findings of tamponade in 50 consecutive patients with suspected traumatic pericardial tamponade who underwent creation of a subxiphoid pericardial window. There were no deaths or complications from the procedure. The early use of subxiphoid pericardial window has been a major factor in reducing our mortality rate from penetrating heart wounds to 12% overall, and 8% in the past three years.

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