How to Deal with Complicated Pericardial Effusion?

Author : G.M. Rahman, I.G.R. Suryawan
Upload Date : 19-04-2018

Introduction: Emergent Pericardiosentesis is the life-saving procedure in patient with massive pericardial effusion (PE) and cardiac tamponade. Despite relatively safe, it was associated with serious complication and potentially fatal. If there were any clinical and anatomical complication, this procedure become more dilemmatic to be performed.

Case 1 : A 46 y.o female with critical mitral stenosis and severe pulmonary hypertension accompanied by massive PE and hemodynamic compromise. Emergent echocardiographic-guiding pericardiosentesis succesfully performed.

Case 2 : A 18 y.o male with massive PE with large malignant mediastinum mass compressed the right atrium. Emergent pericardiosentesis was postponed related to anatomical complication and stable hemodynamic during observation. Multidicipline discussion decided that the urgent open pericardiostomy had to be performed.

Case 3 : A 75 y.o male with massive PE and intra-pericardial mass. With the consideration of high comorbidity and short life expectancy, multidiscipline discussion decided to treat the patient conservatively.

Conclusion: Careful patient selection, taking into consideration of the anatomical location, volume, hemodynamic consequences, and method of pericardial fluid evacuation remain mandatory in patient with complicated PE. Different management approach was highly depend on the etiology, volume and location of the PE, as well as comorbidities.

KEYWORDS : Deal-Complicated-Pericardial-Effusion

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