Nour-Eldin Nour-Eldin Abdelrehim, Alsubhi Mohammed, Gruber-Rouh Tatjana, Vogl Thomas J, Kaltenbach Benjamin, Soliman Hazem Hamed, Hassan Wael Eman, Abolyazid Sherif Maher, Naguib Nagy N
Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Frankfurt am Main, Germany.
Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt.
Cardiovasc Intervent Radiol. 2017 Aug;40(8):1223-1228. doi: 10.1007/s00270-017-1624-2. Epub 2017 Mar 23.
This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery.
The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF) <50%. The preintervention ejection fraction was determined echocardiographically with value between 30 and 40%. Exclusion criteria for drainage were hemodynamically unstable patients or impaired coagulation profile (INR <1.8 or platelet count <75,000). Drains (8F-10F) were applied using Seldinger's technique under CT guidance.
Pericardiocentesis and placement of a percutaneous pericardial drain was technically successful in all patients. The mean volume of evacuated pericardial effusion was 260 ml (range 80-900 ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40-55% (mean: 45%; SD: ±5; p < 0.05). The mean percentage increase of the EF following pericardial effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p < 0.05) in comparison to the preventricular position of the catheter. Recorded complications included minimal asymptomatic pneumothorax and pneumomediastinum 2.3% (3/128) and sinus tachycardia 3.9% (5/128).
CT-guided drainage of postoperative pericardial effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.
本研究旨在评估心脏手术后患者经CT引导的心包积液引流术的安全性和有效性。
本研究纳入了2008年6月至2016年6月期间128例连续的心脏手术后并发心包积液或血心包的患者（男性82例，女性46例；平均年龄66.6岁，标准差：4.2）。所有患者进行治疗性心包穿刺术的医学指征是心包积液导致的血流动力学不稳定。干预的治疗标准是有心包填塞证据且射血分数（EF）<50%。干预前的射血分数通过超声心动图测定，值在30%至40%之间。引流的排除标准是血流动力学不稳定的患者或凝血功能受损（国际标准化比值[INR]<1.8或血小板计数<75,000）。在CT引导下采用Seldinger技术应用引流管（8F - 10F）。
所有患者的心包穿刺和经皮心包引流管置入在技术上均成功。抽出的心包积液平均量为260毫升（范围80 - 900毫升；标准差[SD]：±70）。心包穿刺后，射血分数显著提高至40% - 55%（平均：45%；标准差：±5；p<0.05）。心包积液引流后EF的平均增加百分比为10%。128例中有39例（30.5%）在前室（心室前）进行引流，33例（25.8%）在心室后进行引流，56例（43.8%）在心内下进行引流。拔除引流管后心包积液复发率为4.7%（67/128）。与导管置于心室前位置相比，导管置于心室后和心内下位置时实现了完全引流（p<0.05）。记录的并发症包括轻微无症状气胸和纵隔气肿2.3%（3/128）以及窦性心动过速3.9%（5/128）。
CT引导下术后心包积液引流是一种微创技术，可解除积液的心包填塞效应并改善心输出量。
