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Clinical Investigations: CARDIOLOGY |

Technical and Prognostic Outcomes of Double-Balloon Pericardiotomy for Large Malignancy-Related Pericardial Effusions*

Huang-Joe Wang, MD; Kwan-Lih Hsu, MD, PhD; Fu-Tien Chiang, MD, PhD; Chuen-Den Tseng, MD, PhD; Yung-Zu Tseng, MD; Chiau-Suong Liau, MD
Author and Funding Information

*From the Cardiology Section, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Correspondence to: Kwan-Lih Hsu, MD, PhD, Cardiology Section, Department of Internal Medicine, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei, 100, Taiwan; e-mail: klhsu@ha.mc.ntu.edu.tw



Chest. 2002;122(3):893-899. doi:10.1378/chest.122.3.893
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Objective: To investigate both the use of immediate or elective double-balloon pericardiotomy (DBP) in patients with a large amount of malignancy-related pericardial effusion, and the prognosis of this subgroup.

Design: Observational study after DBP intervention.

Setting: Tertiary referral center.

Patients and interventions: Fifty patients with malignancy, mainly lung and breast cancer, who were admitted to our critical care unit with a large amount of pericardial effusion. All received echocardiographic-guided pericardiocentesis. Group 1 consisted of 12 patients (24%) who received immediate DBP, and group 2 consisted of 38 patients (76%) who received delayed DBP 2.5 ± 1.7 days later (mean ± SD) after emergency pericardiocentesis with pigtail catheter drainage.

Measurements: After the procedure, and at 1 month, 3 months, and 6 months, echocardiography and chest radiography were performed to check for pneumothorax, pericardial effusion reaccumulation, or the appearance of pleural effusion after pigtail catheter removal.

Main results: The procedure was successful and without recurrence in 44 patients (88%). Procedural complications were fever in 4 patients (33%) and 10 patients (26%) in group 1 and group 2, respectively (p = 0.72), and mild pneumothorax in 2 patients (17%) and 1 patient (3%) in group 1 and group 2, respectively (p = 0.14). Fifty percent of the patients died within 4 months, while 25% survived to 11 months. High serum calcium, a low albumin/globulin ratio, and positive results on pericardial effusion cytology were poor prognostic factors for long-term survival.

Conclusion: Both immediate and delayed DBP are a safe and effective method of relieving large pericardial effusions in patients with cancer. Successful DBP without recurrence of pericardial effusion was achieved in 88% of all patients. Survival was related to the extent of the disease.

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