Management of acute cardiac tamponade by subxiphoid pericardiotomy

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Abstract
Eighteen patients with cardiac tamponade were treated by subxiphoid pericardiotomy performed with the patients under local anesthesia. This group included 9 cases of uremic pericarditis (50%), 5 cases of metastatic cancer (28%), 2 cases of trauma (11%), 1 case of tuberculosis (5.5%) and 1 case of unknown cause. Immediate relief from acute cardiac tamponade was obtained in all 18 cases with only minor and self-limiting postoperative complications, including transient supraventricular arrhythmias (5 cases) and fever (5 cases). There were no deaths related to the operative procedure or reaccumulation of the pericardial effusion. The drainage period averaged 9.6 days (range, 3-28 days). Pericardial biopsy was performed in 15 of 18 cases. Subxiphoid pericardiotomy apparently is a safe and effective method for the management of pericardial effusion of diverse causes. The ability to perform this technique safely using local anesthesia and the capacity to obtain a biopsy specimen under direct visualization make this technique superior to both needle pericardiocentesis and pericardiectomy in the acutely ill patient.