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The Annals of Thoracic Surgery, Vol 31, 512-519, Copyright © 1981 by The Society of Thoracic Surgeons
AM Borkon, HV Schaff, TJ Gardner, WH Merrill, RK Brawley, JS Donahoo, L Watkins Jr, JL Weiss and VL Gott
The clinical and laboratory findings of 28 patients identified as having
late pericardial effusions were examined. Eleven of these patients were
asymptomatic; 9 patients had moderate symptoms including fatigue, malaise,
weight gain, and dyspnea on exertion, and 8 patients with similar symptoms
had evidence of cardiac tamponade. Ten patients underwent right heart
catheterization in the intensive care unit; normal hemodynamics were
confirmed in 4 and cardiac tamponade in 6 patients. Pericardiocentesis was
effective in decompressing cardiac tamponade in 7 of 8 patients. One
patient required operative subxiphoid drainage after unsuccessful
pericardiocentesis. In addition, 5 patients with moderate clinical symptoms
and pericardial effusions, who did not have cardiac tamponade, underwent
pericardiocentesis because of a need for chronic anticoagulant therapy. The
remaining patients were managed successfully by observation,
discontinuation of warfarin when possible, fluid restriction, and diuretic
therapy. All but 1 patient was symptomatically improved. A diagnostic and
therapeutic schema is presented as an aid to early recognition of this
troublesome and potentially lethal complication.
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Diagnosis and management of postoperative pericardial effusions and late cardiac tamponade following open-heart surgery
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