Management of malignant pericardial effusions

Abstract

The optimal treatment of patients with symptomatic pericardial effusion remains controversial. The goals of treatment are complete drainage of the effusion and acquisition of tissue and fluid for pathological analysis and microbiologic culture. Ideally, this should be performed using a method with minimal morbidity and a low risk for recurrence of the effusion. Therapeutic options include pericardiocentesis, percutaneous catheter drainage, open subxiphoid pericardial drainage (with or without the creation of a pericardioperitoneal window), and transthoracic drainage with creation of a pericardiopleural window. The choice of drainage procedure is significantly influenced by the physiological reserve of the patient and the need for a definitive diagnosis of the cause of the effusion. © 2007 Springer-Verlag London Limited.