Pericardial windows have limited diagnostic success

Our plain-English summary of Pericardial windows have limited diagnostic success, by L. Volk, H. Ikegami, L.Y. Lee, et al (Journal of Cardiothoracic Surgery, 2018).

The study

• Authors: L. Volk, H. Ikegami, L.Y. Lee, A. Lemaire
• Journal: Journal of Cardiothoracic Surgery
• Published: 2018;13(1):87
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial effusion (PE) is a common finding in patients who have chronic cardiac failure, who had undergone cardiac surgery, or who have certain other benign and malignant diseases. Pericardial drainage procedures are often requested for both diagnostic and therapeutic purposes. The perceived benefit is that it allows for diagnosis of malignancy or infection for patients with PEs of unclear etiology. The purpose of the study is to determine the diagnostic yield of surgical drainage procedures.

Methods: We conducted a retrospective chart review of patients who underwent surgical drainage procedures of PEs from July 1st, 2011 to January 1st, 2017 at a single institution. The variables included data on preoperative, intraoperative, and postoperative findings; morbidity; and survival.

Results: A total of 145 patients with an average age of 61 ± 5 and primarily men (53%) were evaluated. All of the surgical drainage procedures were performed through the sub-xiphoid approach. Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid. The cytology alone was diagnostic in 4.8% (N = 7) of patients with mixed findings including adenocarcinoma of the lung and breast. The pathology was diagnostic for cancer in 1.4% (N = 2) of patients with Melanoma and Lung cancer identified. The cytology and pathology were concordant in 4.0% (N = 6) identifying cancers that included mesothelioma and adenocarcinoma. Infection was identified in the pericardial fluid in 6.9% (N = 10) of the patients.

Conclusion: Surgical pericardial drainage procedures allow for removal of PE that may lead to tamponade physiology and potential mortality. Although there is therapeutic benefit from these procedures there is only a small diagnostic benefit.

In plain English

This study looked back at the medical charts of 145 patients who had surgery to drain fluid from around the heart (a pericardial effusion) at a single academic medical institution between July 1, 2011 and January 1, 2017. The study did not examine asbestos exposure. All operations, called pericardial windows, were done through a small incision below the breastbone (the sub-xiphoid approach). Fluid and a sample of the heart's lining (pericardium) were sent for testing. Twenty-five of the 145 patients (17.2%) had a diagnostic finding. Testing of the fluid (cytology) alone found cancer in 7 patients, and testing of the tissue (pathology) alone found cancer in 2. In 6 patients both tests agreed, and the cancers in that group included mesothelioma and adenocarcinoma. Infection was found in the fluid of 10 patients. One patient had a puncture of the right ventricle that required a full opening of the breastbone to repair, and no patients died from the procedures. The authors concluded that these procedures have therapeutic benefit but only a small (17.2%) diagnostic benefit.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective chart review at a single institution
• Who was studied: 145 patients who had surgical drainage of a pericardial effusion at a single academic medical institution (approved by the review board at Rutgers Robert Wood Johnson Medical School), July 1, 2011 to January 1, 2017. Average age was 61 (plus or minus 5), and 53% were men.
• Exposure: No asbestos or other exposure was studied. The subject was the surgical drainage procedure (pericardial window), with at least 50 cc of fluid sent for cytology and microbiology and a pericardium sample sent for pathology. All procedures used the sub-xiphoid approach.
• Main results:
  • Twenty-five of the 145 patients (17.2%) had diagnostic findings in either the pericardial tissue or fluid.
  • Cytology alone was diagnostic in 4.8% (N = 7) of patients, with findings including adenocarcinoma of the lung and breast.
  • Pathology alone was diagnostic for cancer in 1.4% (N = 2) of patients (melanoma and lung cancer).
  • Cytology and pathology agreed in 4.0% (N = 6) of patients, identifying cancers that included mesothelioma and adenocarcinoma. The table lists one mesothelioma, with source given as lung.
  • Infection was found in the pericardial fluid of 6.9% (N = 10) of patients.
  • Pericardial biopsy added findings not otherwise given by cytology in only 2 patients, while cytology was diagnostic in 13 patients.
  • There was 1 complication (a right ventricular perforation requiring conversion to full sternotomy and repair). No patients died from the procedures.
• The authors' conclusion: The authors concluded that surgical pericardial drainage has therapeutic benefit but only a small (17.2%) diagnostic benefit.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Pericardial Effusion, Etiology, Cytology, Adenocarcinoma, Pathology, Lung Cancer, Mesothelioma.

Related studies

• Pericardial Mesothelioma in a 35-Year-Old Male With Ulcerative Colitis — J. Iliff, N.K. Bart, et al. (2019)
• Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review — H. Itagaki, T. Yamamoto, et al. (2020)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)
• Tetracycline sclerosis in the management of malignant pericardial effusion — F.A. Shepherd, J.S. Ginsberg, et al. (1985)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• New nonsurgical technique for multiple pericardial biopsies — J. Endrys, M. Simo, et al. (1988)

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