Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil.
Braz J Cardiovasc Surg. 2021 Aug 6;36(4):581-583. doi: 10.21470/1678-9741-2020-0355.
The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less frequent and surgical intervention is usually necessary. However, there are some rare cases of large effusions that are recurrent even after intervention and become challenging to treat.
We describe the case of a patient submitted to coronary artery bypass grafting (CABG) without any intraoperative complications, who was regularly discharged from the hospital. She was referred to our emergency department twice after surgery with large pericardial effusion that was drained. Even after those two interventions and with adequate oral medication, the large effusion recurred.
During follow-up, the patient had her symptoms resolved, with no need for further hospital admission. Her echocardiograms after the last intervention showed no pericardial effusion. The present surgical technique demonstrated to be easy to perform, thus it should be considered as a treatment option for these rare cases of large and repetitive effusions, which do not respond to the traditional methods.
In challenging cases of recurrent and large pericardial effusions, the pericardial-peritoneal window is an alternative surgical technique that brings clinical improvement and diminishes the risk of cardiac tamponade.
心脏手术后出现轻度至中度心包积液较为常见，通常可以采用口服药物治疗。积液量较大的情况较少见，通常需要手术干预。然而，有些罕见的大积液病例即使经过干预也会反复出现，治疗起来颇具挑战性。
我们描述了一位患者的病例，该患者在冠状动脉旁路移植术（CABG）过程中无任何手术并发症，且术后常规出院。她在手术后两次因大量心包积液被送入我院急诊室进行引流。尽管经过这两次干预和适当的口服药物治疗，大积液仍再次出现。
在随访期间，患者的症状得到缓解，无需再次住院。最后一次干预后的超声心动图显示心包无积液。目前的手术技术易于操作，因此应考虑将其作为治疗这些罕见的大且反复出现、对传统方法无反应的积液病例的一种选择。
对于反复出现且大量的心包积液的棘手病例，心包-腹膜窗是一种替代的手术技术，可带来临床改善并降低心脏压塞的风险。
