Abstract
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.
Highlights
The incidence of pericardial effusion (PE) after pediatric cardiac surgery has decreased due to advances in perioperative medical care techniques; it is still not uncommon
In the absence of cardiac tamponade, there is no standard treatment established for postoperative PE, as the preferred treatment differs between various institutions
Several studies have indicated that oral aspirin is often selected as the initial treatment for postpericardiotomy syndrome, whereas additional steroids and colchicine are administered in refractory cases [2,3,4]
Summary
The incidence of pericardial effusion (PE) after pediatric cardiac surgery has decreased due to advances in perioperative medical care techniques; it is still not uncommon. The postoperative PE should be taken care, because it carries the risk of progressing to cardiac tamponade. In the event of accompanying cardiac tamponade, it is generally accepted that pericardial drainage should be indicated [1]. Several studies have indicated that oral aspirin is often selected as the initial treatment for postpericardiotomy syndrome, whereas additional steroids and colchicine are administered in refractory cases [2,3,4]. There is no consensus regarding the doses to be administered, administration methods, or durations. It takes time for the therapeutic effects to appear. Shortterm oral prednisolone administration is the initial treatment for postoperative PE without cardiac tamponade. We retrospectively evaluated the effectiveness of this treatment
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