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. 1994 Oct;72(4):327–331. doi: 10.1136/hrt.72.4.327

Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.

M Pepi 1, M Muratori 1, P Barbier 1, E Doria 1, V Arena 1, M Berti 1, F Celeste 1, M Guazzi 1, G Tamborini 1
PMCID: PMC1025541  PMID: 7833189

Abstract

OBJECTIVE--To evaluate the incidence, characteristics, and haemodynamic consequences of pericardial effusion after cardiac surgery. DESIGN--Clinical, echocardiographic, and Doppler evaluations before and 8 days after cardiac surgery; with echocardiographic and Doppler follow up of patients with moderate or large pericardial effusion after operation. SETTING--Patients undergoing cardiac surgery at a tertiary centre. PATIENTS--803 consecutive patients who had coronary artery bypass grafting (430), valve replacement (330), and other types of surgery (43). 23 were excluded because of early reoperation. MAIN OUTCOME MEASURES--Size and site of pericardial effusion evaluated by cross sectional echocardiography and signs of cardiac tamponade detected by ultrasound (right atrial and ventricular diastolic collapse, left ventricular diastolic collapse, distension of the inferior vena cava), and Doppler echocardiography (inspiratory decrease of aortic and mitral flow velocities). RESULTS--Pericardial effusion was detected in 498 (64%) of 780 patients and was more often associated with coronary artery bypass grafting than with valve replacement or other types of surgery; it was small in 68.4%, moderate in 29.8%, and large in 1.6%. Loculated effusions (57.8%) were more frequent than diffuse ones (42.2%). The size and site of effusion were related to the type of surgery. None of the small pericardial effusions increased in size; the amount of fluid decreased within a month in most patients with moderate effusion and in a few (7 patients) developed into a large effusion and cardiac tamponade. 15 individuals (1.9%) had cardiac tamponade; this event was significantly more common after valve replacement (12 patients) than after coronary artery bypass grafting (2 patients) or other types of surgery (1 patient after pulmonary embolectomy). In patients with cardiac tamponade aortic and mitral flow velocities invariably decreased during inspiration; the echocardiographic signs were less reliable. CONCLUSIONS--Pericardial effusion after cardiac surgery is common and its size and site are related to the type of surgery. Cardiac tamponade is rare and is more common in patients receiving oral anticoagulants. Echo-Doppler imaging is useful for the evaluation of pericardial fluid accumulations after cardiac surgery. It can identify effusions that herald cardiac tamponade.

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Selected References

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  1. Appleton C. P., Hatle L. K., Popp R. L. Cardiac tamponade and pericardial effusion: respiratory variation in transvalvular flow velocities studied by Doppler echocardiography. J Am Coll Cardiol. 1988 May;11(5):1020–1030. doi: 10.1016/s0735-1097(98)90060-2. [DOI] [PubMed] [Google Scholar]
  2. Armstrong W. F., Schilt B. F., Helper D. J., Dillon J. C., Feigenbaum H. Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study. Circulation. 1982 Jun;65(7):1491–1496. doi: 10.1161/01.cir.65.7.1491. [DOI] [PubMed] [Google Scholar]
  3. Asanza L., Rao G., Voleti C., Hartstein M. L., Wisoff B. G. Should the pericardium be closed after an open-heart operation? Ann Thorac Surg. 1976 Dec;22(6):532–534. doi: 10.1016/s0003-4975(10)64471-2. [DOI] [PubMed] [Google Scholar]
  4. Battle R. W., LeWinter M. M. The evaluation and management of pericardial disease. Curr Opin Cardiol. 1990 Jun;5(3):331–339. doi: 10.1097/00001573-199006000-00014. [DOI] [PubMed] [Google Scholar]
  5. Beppu S., Tanaka N., Nakatani S., Ikegami K., Kumon K., Miyatake K. Pericardial clot after open heart surgery: its specific localization and haemodynamics. Eur Heart J. 1993 Feb;14(2):230–234. doi: 10.1093/eurheartj/14.2.230. [DOI] [PubMed] [Google Scholar]
  6. Borkon A. M., Schaff H. V., Gardner T. J., Merrill W. H., Brawley R. K., Donahoo J. S., Watkins L., Jr, Weiss J. L., Gott V. L. Diagnosis and management of postoperative pericardial effusions and late cardiac tamponade following open-heart surgery. Ann Thorac Surg. 1981 Jun;31(6):512–519. doi: 10.1016/s0003-4975(10)61340-9. [DOI] [PubMed] [Google Scholar]
  7. Chuttani K., Pandian N. G., Mohanty P. K., Rosenfield K., Schwartz S. L., Udelson J. E., Simonetti J., Kusay B. S., Caldeira M. E. Left ventricular diastolic collapse. An echocardiographic sign of regional cardiac tamponade. Circulation. 1991 Jun;83(6):1999–2006. doi: 10.1161/01.cir.83.6.1999. [DOI] [PubMed] [Google Scholar]
  8. Feigenbaum H. Ultrasonic cardiology. Diagnostic ultrasound as an aid to the management of patients with pericardial effusion. Dis Chest. 1969 Jan;55(1):59–62. doi: 10.1378/chest.55.1.59. [DOI] [PubMed] [Google Scholar]
  9. Frey M. J., Berko B., Palevsky H., Hirshfeld J. W., Jr, Herrmann H. C. Recognition of cardiac tamponade in the presence of severe pulmonary hypertension. Ann Intern Med. 1989 Oct 1;111(7):615–617. doi: 10.7326/0003-4819-111-7-615. [DOI] [PubMed] [Google Scholar]
  10. Himelman R. B., Kircher B., Rockey D. C., Schiller N. B. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1988 Dec;12(6):1470–1477. doi: 10.1016/s0735-1097(88)80011-1. [DOI] [PubMed] [Google Scholar]
  11. Hochberg M. S., Merrill W. H., Gruber M., McIntosh C. L., Henry W. L., Morrow A. G. Delayed cardiac tamponade associated with prophylactic anticoagulation in patients undergoing coronary bypass grafting. Early diagnosis with two-dimensional echocardiography. J Thorac Cardiovasc Surg. 1978 May;75(5):777–781. [PubMed] [Google Scholar]
  12. Horowitz M. S., Schultz C. S., Stinson E. B., Harrison D. C., Popp R. L. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation. 1974 Aug;50(2):239–247. doi: 10.1161/01.cir.50.2.239. [DOI] [PubMed] [Google Scholar]
  13. Hunter S., Smith G. H., Angelini G. D. Adverse hemodynamic effects of pericardial closure soon after open heart operation. Ann Thorac Surg. 1992 Mar;53(3):425–429. doi: 10.1016/0003-4975(92)90262-3. [DOI] [PubMed] [Google Scholar]
  14. Ikäheimo M. J., Huikuri H. V., Airaksinen K. E., Korhonen U. R., Linnaluoto M. K., Tarkka M. R., Takkunen J. T. Pericardial effusion after cardiac surgery: incidence, relation to the type of surgery, antithrombotic therapy, and early coronary bypass graft patency. Am Heart J. 1988 Jul;116(1 Pt 1):97–102. doi: 10.1016/0002-8703(88)90255-4. [DOI] [PubMed] [Google Scholar]
  15. Martin R. P., Rakowski H., French J., Popp R. L. Localization of pericardial effusion with wide angle phased array echocardiography. Am J Cardiol. 1978 Dec;42(6):904–912. doi: 10.1016/0002-9149(78)90674-4. [DOI] [PubMed] [Google Scholar]
  16. Merrill W., Donahoo J. S., Brawley R. K., Taylor D. Late cardiac tamponade: a potentially lethal complication of open-heart surgery. J Thorac Cardiovasc Surg. 1976 Dec;72(6):929–932. [PubMed] [Google Scholar]
  17. Nandi P., Leung J. S., Cheung K. L. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade. Br Heart J. 1976 Dec;38(12):1319–1323. doi: 10.1136/hrt.38.12.1319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pepi M., Doria E., Fiorentini C. Cardiac tamponade produced by a loculated pericardial hematoma simulating a right atrial mass. Int J Cardiol. 1990 Dec;29(3):383–386. doi: 10.1016/0167-5273(90)90130-w. [DOI] [PubMed] [Google Scholar]
  19. Reydel B., Spodick D. H. Frequency and significance of chamber collapses during cardiac tamponade. Am Heart J. 1990 May;119(5):1160–1163. doi: 10.1016/s0002-8703(05)80248-0. [DOI] [PubMed] [Google Scholar]
  20. Schutzman J. J., Obarski T. P., Pearce G. L., Klein A. L. Comparison of Doppler and two-dimensional echocardiography for assessment of pericardial effusion. Am J Cardiol. 1992 Nov 15;70(15):1353–1357. doi: 10.1016/0002-9149(92)90774-s. [DOI] [PubMed] [Google Scholar]
  21. Shabetai R. Changing concepts of cardiac tamponade. J Am Coll Cardiol. 1988 Jul;12(1):194–195. doi: 10.1016/0735-1097(88)90373-7. [DOI] [PubMed] [Google Scholar]
  22. Simpson I. A., Munsch C., Smith E. E., Parker D. J. Pericardial haemorrhage causing right atrial compression after cardiac surgery: role of transoesophageal echocardiography. Br Heart J. 1991 Jun;65(6):355–356. doi: 10.1136/hrt.65.6.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Singh S., Wann L. S., Schuchard G. H., Klopfenstein H. S., Leimgruber P. P., Keelan M. H., Jr, Brooks H. L. Right ventricular and right atrial collapse in patients with cardiac tamponade--a combined echocardiographic and hemodynamic study. Circulation. 1984 Dec;70(6):966–971. doi: 10.1161/01.cir.70.6.966. [DOI] [PubMed] [Google Scholar]
  24. Susini G., Pepi M., Sisillo E., Bortone F., Salvi L., Barbier P., Fiorentini C. Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion. J Cardiothorac Vasc Anesth. 1993 Apr;7(2):178–183. doi: 10.1016/1053-0770(93)90213-5. [DOI] [PubMed] [Google Scholar]
  25. Weitzman L. B., Tinker W. P., Kronzon I., Cohen M. L., Glassman E., Spencer F. C. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. 1984 Mar;69(3):506–511. doi: 10.1161/01.cir.69.3.506. [DOI] [PubMed] [Google Scholar]

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