Is a small amount of pericardial effusion serious?

The main causes of pericardial effusion are non-infectious causes and infectious causes. There are many causes of infection, such as viruses and bacteria, while non-infectious causes are generally caused by tumors, rheumatoid arthritis and other diseases. If a small amount of effusion occurs, it should be checked in time. In addition to good treatment, emphasis should be placed on nutrition.

Treatment of pericardial effusion

1. Medical treatment

Drug treatment includes the use of hormones, anti-inflammatory drugs, anti-tuberculosis drugs and other causative treatments. When there are no symptoms, the patient can be observed without medication.

Pericardiocentesis can relieve symptoms and extract pericardial fluid for analysis to aid diagnosis and treatment, but its own therapeutic effect is not certain and it is no longer the main treatment method.

2. Surgical treatment

The purpose of surgical treatment is to relieve existing or potential pericardial obstruction, clear pericardial effusion, reduce the possibility of recurrence of pericardial effusion, and prevent late pericardial stenosis.

If the diagnosis is clear and drug treatment is ineffective, pericardial drainage and pericardiectomy can be performed for this disease.

(1) Subxiphoid pericardial drainage is simple and rapid to operate, causes less damage, has clear short-term effects, and has fewer pulmonary complications. It is suitable for critically ill patients and elderly patients; however, the recurrence rate of pericardial effusion after surgery is high. To reduce the recurrence rate, the extent of pericardial resection can be increased.

It was first called pericardial window in the 1970s. However, the therapeutic mechanism of pericardial fenestration has only been understood in recent years. Studies have shown that on the basis of continuous and adequate drainage, fibrous adhesions appear between the epicardium and pericardium, and the pericardial cavity disappears, which is the reason why pericardial fenestration has long-term therapeutic effects.

Technique of subxiphoid pericardial drainage: The incision starts from the lower end of the sternum and extends downward, with a total length of 6 to 8 cm. A midline incision was made on the upper part of the linea alba to expose and remove the xiphoid process. Bluntly separate the loose tissue between the posterior wall of the sternum and the anterior wall of the pericardium. Use an external retractor to expose the upper abdominal incision and use a right-angle retractor to pull up the lower end of the sternum. The anterior pericardial wall was incised and the pericardial fluid was removed. The pericardium was removed to about 3cm×3cm and the pericardial window was completed. A pericardial drainage tube was placed through another small incision next to the incision. Suture the incision. The pericardial drainage tube is left in place for 4 to 5 days.

(2) Partial or complete pericardectomy and chest drainage: This method provides complete drainage and has a low recurrence rate. Since more pericardium is removed, the sources of pericardial effusion and pericardial stenosis are reduced, so the surgical effect is accurate and reliable. However, the surgery causes significant damage and may lead to lung and incision complications.

(3) Pericardectomy and chest drainage using VATS can remove the pericardium over a larger area with minimal damage and satisfactory drainage. There are fewer postoperative complications. But anesthesia is more complicated.