Ann Thorac Surg 1994;57:289-292
© 1994 The Society of Thoracic Surgeons
Articles
Pericardioperitoneal shunt: An alternative treatment for malignant pericardial effusion
Nan Wang, MD*,
J.Randall Feikes, MD,
Thomas Mogensen, BS,
Edwin E. Vyhmeister, MD,
Leonard L. Bailey, MD
Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
* Address reprint requests to Dr Wang, Department of Surgery, Lama Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354.
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Abstract
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The treatment of 37 consecutive cases of symptomatic malignant pericardial effusion over a period of 13 years was retrospectively analyzed. The most common diagnoses were lung cancer (59%) and breast cancer (11%). In the most recent 4 patients, the Denver pleuroperitoneal shunt was used to drain the pericardial effusion into the peritoneal cavity. In each case, the procedure was performed under local anesthesia, and the patient was discharged 2 to 4 days later without complications. Three of the patients subsequently died of the disease process without evidence of cardiac failure or tamponade during 6-month follow-up. The more traditionl events of pericardial drainage, the subxiphoid approach (14 patients) and the anterior thotacotomy approach (19 patients), were associated with higher postoperative morbidity (21% and 53%, respectively) and mortality (7% and 42%, respectively). Because of the small number of patients treated by pericardioperitoneal shunting, a significant difference was demonstrated only in the length of hospital stay (shunt, 2.8 ± 0.5 days; subxiphoid, 11.2 ± 4.6 days; thoracotomy, 14.9 ± 6.1 days). Median survivals were essentially the same (shunt, 3.5 months; subxiphoid, 2.7 months; thoracotomy, 1.2 months). It is apparent that the pericardioperitoneal shunt, although a much simpler procedure, can accomplish similar palliation effectively in the treatment of malignant pericardial effusion.
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Footnotes
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Presented at the Poster Session of the Twenty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Anlonio. TX. Jan 25–27, 1993.
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References
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- Larrey DJ. New surgical procedure to open the pericardium in case of fluid in its cavity Clin Chir 1829;2:303-337.
- Park SP, Rentschler R, Wilbur D. Surgical management of pericardial effusion in patients with malignancies: comparison of subxiphoid window versus pericardiectomy Cancer 1991;67:76-80.[Medline]
- Sugimolo JT, Little AG, Ferguson MK, et al. Pericardial window: mechanisms of efficacy Ann Thorac Surg 1990;50:442-445.[Abstract/Free Full Text]
- Smith FE, Lane M, Hudgins P. Conservative management of pericardial effusion Cancer 1974;33:47-57.[Medline]
- Hankins JR, Satlerfield JR, Aisner J, Wiernik PH, McLaughlin JS. Pericardial window for malignant pericardial effusion Ann Thprac Surg 1980;30:465-471.
- Snow N, Lucas A. Subxiphoid pericardiotamy: a safe, accurate, diagnostic and therapeutic approach to pericardial and intrapericardial disease Am Surg 1983;49:249-253.[Medline]
- Larrieu AJ, Ghosh SC, Ablaza SG, Grana VP. Favorable results with the subxiphoid pericardial window technique J Thorac Cardiovasc Surg 1986;91:639-640.[Medline]
- Santos GH, Frater RWM. The subxiphoid approach in the treatment of pericardial effusion Ann Thorac Surg 1977;23:467-470.[Abstract/Free Full Text]
- Piehler JM, Pluth JR, Schaff HV, Danielson GK, Orszulak TA, Puga FJ. Surgical management of effusive pericardial disease Influence of extent of pericardial resection on clinical course J Thorac Cardiovasc Surg 1985;90:506-516.[Abstract]
- Spodick DH. Pericardial windows are suboptimal [Letter] Am J Cardiol 1983;51:607.[Medline]
- Little AG, Kadowaki MH, Ferguson MK, Staszek VM, Skinner DB. Pleuro-peritoneal shunting Alternative therapy for pleural effusions Ann Surg 1988;208:443-450.[Medline]
- Krikorian JG, Hancock EW. Pericardiocentesis Am J Med 1978;65:808-814.[Medline]
- Shepherd FA, Ginsberg JS, Evans WK, Scott JG, Oleksiuk P. Tetracycline sclerosis in the management of malignant pericardial effusion J Clin Oncol 1985;3:1678-1682.[Abstract/Free Full Text]
- Martini N, Freiman A, Watson R, Hilaris B. Intrapericardial instillation of radioactive chromic phosphate in malignant pericardial effusion AJR 1977;128:639-641.[Abstract]
- Cham WC, Freeman AH, Carstens PHB. Radiation therapy of cardiac and pericardial métastases Ther Radiol 1975;114:701.
- Dean RH, Killen DA, Daniel Jr RA, Collins HA. Experience with pericardiectomy Ann Thorac Surg 1973;15:378-385.[Abstract/Free Full Text]
- Little AG, Kremser PC, Wade JL, Levett JM, DeMeester TR, Skinner DB. Operation for diagnosis and treatment of pericardial effusions Surgery 1984;96:738-744.[Medline]
- Griffin S, Fountain W. Pericardio-peritoneal shunt for malignant pericardial effusion [Letter] J Thorac Cardiovasc Surg 1989;98:1153-1154.[Medline]
- Molnar TF, Jeyasingham K. Pericardioperitoneal shunt for persistent pericardial effusions: a new drainage procedure Ann Thorac Surg 1992;54:569-570.[Abstract/Free Full Text]
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