Department of Cardiovascular Surgery, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, 989-3126, Japan.
Pediatr Cardiol. 2022 Apr;43(4):764-768. doi: 10.1007/s00246-021-02783-y. Epub 2021 Dec 1.
A standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. We evaluated the efficacy of short-term oral prednisolone administration, which is the initial treatment for postoperative pericardial effusion without cardiac tamponade at our institution. Between October 2008 and March 2020, 1429 pediatric cardiac surgeries were performed at our institution. 91 patients required postoperative treatment for pericardial effusion. 81 were treated with short-term oral prednisolone. Pericardial effusion was evaluated using serial echocardiography during diastole. Pericardial drainage was performed for patients with circumferential pericardial effusion with a maximum diameter of ≥ 10 mm or signs of cardiac tamponade. Short-term oral prednisolone treatment was administered to patients with circumferential pericardial effusion with a maximum diameter of < 10 mm or localized pericardial effusion with a maximum diameter of ≥ 5 mm. Patients with localized pericardial effusion with a maximum diameter of < 5 mm were observed. Prednisolone (2 mg/kg/day) was administered orally for 3 days, added as needed. Short-term oral prednisolone treatment was effective in 71 cases and 90% of patients were regarded as responders. The remaining patients were deemed non-responders who required pericardial drainage. Overall, 55 responders were deemed early responders whose pericardial effusion disappeared within 3 days. There were no cases of deaths, infections, or recurrence of pericardial effusion. The amount of drainage fluid on the day of surgery was higher in the non-responders. In conclusion, short-term oral prednisolone treatment is effective and safe for treating pericardial effusion without cardiac tamponade after pediatric cardiac surgery.
小儿心脏手术后无心脏压塞的心包积液尚无标准治疗方法。我们评估了我院术后无心脏压塞的心包积液初始治疗即短期口服泼尼松的疗效。2008 年 10 月至 2020 年 3 月，我院共进行了 1429 例小儿心脏手术。91 例患儿术后需心包积液治疗。81 例行短期口服泼尼松治疗。通过舒张期连续超声心动图评估心包积液。对于最大直径≥10mm 的环形心包积液或有心脏压塞迹象的患者进行心包引流。对于最大直径<10mm 的环形心包积液或最大直径≥5mm 的局限性心包积液患者给予短期口服泼尼松治疗。对于最大直径<5mm 的局限性心包积液患者进行观察。泼尼松（2mg/kg/天）口服 3 天，必要时加量。71 例有效，90%的患者为应答者。其余患者被认为是非应答者，需要心包引流。总的来说，55 例应答者为早期应答者，其心包积液在 3 天内消失。无死亡、感染或心包积液复发的病例。非应答者手术当天引流液量较高。总之，短期口服泼尼松治疗小儿心脏手术后无心脏压塞的心包积液是有效且安全的。
