JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery.

eISSN: 2980-1397
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Outcomes of the pediatric patients undergoing pericardiocentesis for cardiac surgery-related massive pericardial effusion
Abstract
Aims: In this study, we aimed to evaluate the demographic and clinical characteristics of the patients who have moderate or severe cardiac surgery related pericardial effusion and relieved by pericardiocentesis.
Methods: Twenty-one children (0-18 years of age) were identified retrospectively in a 10-year period (2010-2020) and we reviewed our medical records for demographic and clinical characteristics, management strategies and outcome of the patients.
Results: Twenty-one patients were identified with a male to female ratio of 1.1. Mean age and body weight of the patients were 79.7 ± 56.6 months and 19.5 ± 14 kg respectively. Of the patients (33%) had at least one complaint, most common being dyspnea (19%) and fatigue (8.5%). The mean period between heart surgery and pericardiocentesis was 30.1±13.4 days. The distribution of surgical indications was as follows; atrial septal defect (42.8%), ventricular septal defect (23.8%), endocardial cushion defect (9.5%). The mean largest diameter of effusion and amount of fluid drained were 34.9 ± 13.4 mm and 349.3 ± 276.1 ml respectively. Macroscopic appearance of the fluid was serous in 28.5%, hemorrhagic in 66.7% and chylous in 4.8% patient. Of the 21 patients 13 were treated with anti-inflammatory drugs; NSAID (14.8%), NSAID and colcihicine (33.3%) NSAID, colchicine and coticosteroid (14.8%). On the follow up 2 (9.5%) patient died because of sepsis and heart failure. There were no procedure related complication, chronic effusion or constriction on the follow up.
Conclusion: In conclusion, PPS is an important clinical syndrome that can lead to serious consequences. Therefore, patients at risk should be identified in the postoperative period and a patient-specific follow-up plan should be made. In the presence of tamponade or serious effusion, pericardiocentesis is a safe, effective and life-saving procedure in patients unresponsive to medical treatment along with anti-inflammatory drugs.

Keywords : Cardiac surgery, pericardial effusion, pericardiocentesis, post-pericardiotomy syndromec

Download Article


1. Adler Y, Charron P, Imazio M, et al. ESC Scientific Document Group. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36:2921-2964. doi:10.1093/eurheartj/ehv318
2. Maranta F, Cianfanelli L, Grippo R, Alfieri O, Cianflone D, Imazio M. Post-pericardiotomy syndrome: insights into neglected postoperative issues. Eur J Cardiothorac Surg. 2022;61(3):505-514. doi:10.1093/ejcts/ezab449
3. Soloff LA, Zatuchui J, Janton OH, et al. Reactivation of rheumatic fever following mitral commissurotomy. Circulation. 1953;8(4):481-497. doi: 10.1161/01.cir.8.4.481
4. Miller RH, Horneffer PJ, Gardner TJ, et al. The epidemiology of the postpericardiotomy syndrome: a common complication of cardiac surgery. Am Heart J. 1988;116(5 Pt 1):1323-1329. doi:10.1016/0002-8703 (88)90457-7
5. Imazio M, Brucato A, Rovere ME, et al. Contemporary features, risk factors, and prognosis of the postpericardiotomy syndrome. Am J Cardiol. 2011;108(8):1183-1187. doi:10.1016/j.amjcard.2011.06.025
6. Elias MD, Glatz AC, O’Connor MJ, et al. Prevalence and risk factors for pericardial effusions requiring readmission after pediatric cardiac surgery. Pediatr Cardiol. 2016;38(3):484-494. doi:10.1007/s00246-016-1540-2
7. Cheung EWY, Ho SA, Tang KKY, Chau AKT, Chiu CSW, Cheung YF. Pericardial effusion after open heart surgery for congenital heart disease. Heart. 2003;89(7):780-783. doi:10.1136/heart.89.7.780
8. Dalili M, Zamani H, Aarabi-Moghaddam M. Pericardial effusion after pediatric cardiac surgeries: a single center observation. Res Cardiovasc Med. 2012;1(1):28-32. doi:10.5812/cardiovascmed.4601
9. Scarfone RJ, Donoghue AJ, Alessandrini EA. Cardiac tamponade complicating postpericardiotomy syndrome. Pediatr Emerg Care. 2003; 19(4):268-271. doi:10.1097/01.pec.0000092573.40174.74
10. Heching HJ, Bacha EA, Liberman L. Post-pericardiotomy syndrome in pediatric patients following surgical closure of secundum atrial septal defects: incidence and risk factors. Pediatr Cardiol. 2015;36(3):498-502. doi:10.1007/s00246-014-1039-7
11. Jones DA, Radford DJ, Pohlner PG. Outcome following surgical closure of a secundum atrial septal defect. J Paediatr Child Health. 2001;37(3): 274-277. doi:10.1046/j.1440-1754.2001.00659.x
12. Lehto J, Gunn J, Karjalainen P, Airaksinen J, Kiviniemi T. Incidence and risk factors of postpericardiotomy syndrome requiring medical attention: the Finland postpericardiotomy syndrome study. J Thorac Cardiovasc Surg. 2015;149(5):1324-1329. doi:10.1016/j.jtcvs.2015.01.031
13. Lehto J, Kiviniemi T. Postpericardiotomy syndrome after cardiac surgery. Ann Med. 2020;52(6):243-264. doi:10.1080/07853890.2020.1758339
14. Kohler I, Saraiva PJ, Wender OB, et al. Behavior of inflammatory markers of myocardial injury in cardiac surgery. Laboratory correlation with the clinical picture of postpericardiotomy syndrome. Arq Bras Cardiol. 2003;81(3):279-290. doi:10.1590/S0066-782X2003001100008
15. Noma M, Hirata Y, Hirahara N, et al. Pericardial effusion after congenital heart surgery. JTCVS Open. 2022;22(9):237-243. doi:10.1016/j.xjon.2022.01.001
16. Concolino D, Pascuzzi A, Pietragalla E, et al. High prevalence of isolated pericardial effusion in Down syndrome. Am J Med Genet A. 2005; 132A(3):331-332. doi:10.1002/ajmg.a.30399
17. Hirashima C, Eguchi Y, Kohmura Y, Minakami H, Sato I. Isolated pericardial effusion and transient abnormal myelopoiesis in a fetus with Down’s syndrome. J Obstet Gynaecol Res. 2000;26(4):303-306. doi:10. 1111/j.1447-0756.2000.tb01326.x
18. Haponiuk I, Kwasniak E, Chojnicki M, et al. Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade-one center’s experience. Wideochir Inne Tech Maloinwazyjne. 2015;10(1): 107-114. doi:10.5114/wiitm.2014.47690
19. Mott AR, Fraser CD Jr, Kusnoor AV, et al. The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass. J Am Coll Cardiol. 200;37(6):1700-1706. doi:10.1016/s0735-1097(01)01223-2
20. Gill PJ, Forbes K, Coe JY. The effect of short-term prophylactic acetylsalicylic acid on the incidence of post-pericardiotomy syndrome after surgical closure of atrial septal defects. Pediatr Cardiol. 2009;30(8): 1061-1067. doi:10.1007/s00246-009-9495-1
21. Imazio M, Trinchero R, Brucato A, et al. Colchicine for the prevention of the post-pericardiotomy syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J. 2010;31(22):2749-2754. doi:10.1093/eurheartj/ehq319
22. Horneffer PJ, Miller RH, Pearson TA, et al. The effective treatment of postpericardiotomy syndrome after cardiac operations. A randomized placebo-controlled trial. J Thorac Cardiovasc Surg. 1990;100(2):292-296. doi:10.1016/S0022-5223(19)35571-0
23. Giacinto O, Minati A, Lusini M, et al. Treatment and prophylaxis of post-pericardiotomy syndrome in cardiac surgery patients: a systematic review. Cardiovasc Drugs Ther. 2023;37(4):771-779. doi:10.1007/s10557-021-07261-4
24. Malektojari A, Tahmasebipour R, Fadaeihosein M, et al. Pharmacological preventions and treatments for pericardial complications after open heart surgeries. Heart. (Published Online First) 2025. doi:10.1136/heartjnl-2024-324805
25. Fields JT, O’Halloran CP, Tannous P, et al. Differences in outcomes between surgical pericardial window and pericardiocentesis in children with postpericardiotomy syndrome. Ann Pediatr Card. 2023;16(6):422-425. doi:10.4103/apc.apc_108_23
Article available in :
Volume 3, Issue 1, 2025
Page : 14-18
https://doi.org/10.51271/JCCVS-0050
Article Information
Received : 04 Oca 2025
Accepted : 22 Mar 2025
Published : 27 Mar 2025
Corresponding Author :

Vehbi Doğan: Departments of Pediatric Cardiology, Dr. Sami Ulus Children Research and Training Hospital, Ankara, Turkiye

[email protected]
Citation : Doğan V, Donbaloğlu F, Sayıcı İU, Koç M. Outcomes of the pediatric patients undergoing pericardiocentesis for cardiac surgery-related massive pericardial effusion. J Cardiol Cardiovasc Surg. 2025;3(1):14-18.

Read: 93
Cited: 0
Download : 49
_Footer