Abstract
Intrapericardial triamcinolone can be used to treat chronic pericardial effusion (PE) in adults; however, pediatric data are lacking. In this case series we aim to evaluate the efficacy, safety, and side effects of intrapericardial triamcinolone in children with PE. The incidence and treatment of post-surgical PE from 2009 to 2019 were determined using the institutional surgical database and electronic patient records. Furthermore, a retrospective analysis of efficacy, safety, and side effects of intrapericardial triamcinolone treatment for chronic post-surgical PE was performed. The incidence of postoperative PE requiring treatment was highest after atrial septal defect (ASD) closure when compared to other types of cardiac surgery (9.7% vs 4.3%). Intrapericardial treatment with triamcinolone resolved pericardial effusion in 3 out of 4 patients. All patients developed significant systemic side effects. Surgical ASD closure is associated with an increased risk of development of PE requiring treatment. Intrapericardial triamcinolone is an effective treatment for chronic postoperative PE in children, but is always associated with significant systemic side effects. Close monitoring and treatment of adrenal insufficiency are mandatory in these cases.
Highlights
The reported prevalence of postoperative pericardial effusion (PE) ranges between 1 and 53% [1–8] in children and adults
The aim of this study was to establish the incidence of PE requiring treatment after pediatric cardiac surgery and to evaluate the efficacy, safety, and side effects of intrapericardial triamcinolone treatment in chronic postoperative pediatric PE
All patients who developed significant post-surgical PE were primarily treated with prednisone
Summary
The reported prevalence of postoperative pericardial effusion (PE) ranges between 1 and 53% [1–8] in children and adults. PE is often responsive to anti-inflammatory therapy, but in a minority of the cases PE becomes chronic. Possible treatment options for chronic PE are pericardiocentesis, creation of a surgical pericardial window, and intrapericardial triamcinolone. Intrapericardial triamcinolone has been associated with dramatic symptomatic improvement in adults [9]. There are no recommendations on intrapericardial triamcinolone treatment of PE in children. It is only known that corticosteroid use should be restricted because of the side effects [10]. The aim of this study was to establish the incidence of PE requiring treatment after pediatric cardiac surgery and to evaluate the efficacy, safety, and side effects of intrapericardial triamcinolone treatment in chronic postoperative pediatric PE
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