Malignant pericardial tamponade.

We studied the clinical course and management of 27 patients with malignant pericardial tamponade seen in a single Medical Center over a 10 year period. Patients treated with repeat pericardial tap as their only mode of therapy had a high rate of recurrent tamponade (6 of 13 subjects) whereas most patients treated with drainage (either surgical or percutaneous) had sustained control of their pericardial effusion (achieved in 10/13 subjects). Intra-pericardial instillation of tetracycline or cyclophosphamide did not clearly improve the good results obtained with drainage alone. Extensive pericardiectomy was required in 2 patients only. Irrespective of the mode of therapy, survival was poor in patients with carcinoma of lung (N = 10) with a median survival of 30 days only vs. 135 days for patients with breast carcinoma (N = 10). Patients with malignant pericardial tamponade are best treated with immediate drainage. Percutaneous and sub-xiphoid surgical drainage are equally effective. Despite invasion of the pericardium by carcinoma, patients with a good oncologic prognosis may enjoy an appreciable survival with adequate quality of life following relief of tamponade.