Surgical Pericardiotomy Research Articles

Surgical pericardiotomy to treat heart failure with preserved ejection fraction: a first clinical study.

Surgical pericardiotomy to treat heart failure with preserved ejection fraction: a first clinical study.

PURULENT PERICARDITIS AND PURULENT PERICARDIAL EFFUSION DUE TO METHICILLIN-SENSITIVE STAPHYLOCOCCUS AUREUS (MSSA) IN A PATIENT TAKING SARILUMAB AND STEROIDS

PURULENT PERICARDITIS AND PURULENT PERICARDIAL EFFUSION DUE TO METHICILLIN-SENSITIVE STAPHYLOCOCCUS AUREUS (MSSA) IN A PATIENT TAKING SARILUMAB AND STEROIDS

Outcomes of malignant pericardial effusion associated with solid cancers based on treatment modality.

e18712 Background: Malignant pericardial effusions (MPE)/Cardiac Tamponade (CT) are often severe manifestations of malignancy, and patients with significant effusions have reduced survival. The most commonly associated solid cancers with MPE are cancers of the lung (L), Breast (B), Esophagus (E), Stomach (S), and Melanoma (M). The data on in-hospital outcomes of MPE based on the treatment modality is relatively limited. Methods: We performed a retrospective study using the National Inpatient Sample (NIS) database from 2016-2019 and identified all admissions with a concomitant discharge diagnosis of MPE/CT and solid cancer (L/B/E/S/M) using ICD 10 codes. These patients were divided into 3 subgroups based on the method of treatment: percutaneous pericardiocentesis only (PP), surgical pericardiotomy only (SP), or both (PP+SP). The three subgroups were compared for outcomes of inpatient mortality, Length of stay (LOS), and total hospitalization charges (THCG). Statistical analysis was done using t-test, chi-square test, and multivariate logistic analysis. Results: 63,939 patients met inclusion criteria (combining the five cancers as above). Of those, 8925, 6119, and 929 patients underwent PP, SP, and both, respectively. The mean age of patients in all three groups was 62 years. Majority of the patients in the three groups were of white ethnicity (69.8%, 72.03%, 60.89 %) and were admitted in large-sized (60%) urban teaching hospitals (82%) and had Medicare (45%). The PP and SP group had more females (54%,56%), and the PP+SP group had a higher proportion of males (53%). 13%,9%, and 14% of the PP, SP, and PP+ SP group patients died during the hospitalization. In comparison to PP group, patients in SP group had a significant decrease in mortality (aOR 0.77, 95% CI 0.61-0.97, p = 0.02*) and the mortality did not change in PP+SP group (aOR 1.10, 95% CI 0.69-1.74, p = 0.6).The mean LOS was 8 days, 9 days, and 12 days in PP, SP, and PP+ SP groups (p < 0.0001*), and the THCG per admission was higher by $28,457 in the SP group and $60,282 in the PP+SP group (p < 0.0001*). Furthermore, Black patients with MPE (aOR = 1.463,95% CI = 1.09-1.95, p = 0.01*) and Failure to thrive comorbidity (aOR = 2.47,95% CI = 1.37-4.4, p = 0.003*) had an increase in mortality regardless of the procedure type. Conclusions: Patients with MPE who underwent surgical pericardiotomy had lower mortality than those who underwent percutaneous pericardiocentesis. In addition, surgical and combined interventions resulted in higher healthcare resource utilization (LOS and THCG). This study highlights the treatment-based mortality difference and notes important trends in demographics. These findings suggest a mindful decision on the type of treatment intervention for MPE. Further studies are needed to evaluate the reasons for racial differences in MPE outcomes and ways to mitigate them. *p value = < 0.05 was considered statistically significant ;aOR = Adjusted Odds Ratio.

Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank

AimTo compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade.MethodsAmong 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis.ResultsWe analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01).ConclusionsIn patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.

Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: A Single-Centre Experience

Cardiac tamponade is a potential complication during extracorporeal membrane oxygenation (ECMO). This study assessed the incidence, clinical presentation, therapeutic approach, and outcome of cardiac tamponade at a single ECMO centre during a 10-year period. Cardiac tamponade occurred in 11 adults (seven men; age 53 years [range, 48-60]) of 566 patients (1.9%), after 10 days (range, 3-16) of ECMO support: eight veno-venous (VV) and three veno-arterial (VA). Cardiac tamponade was suspected due to haemodynamic deterioration or collapse, and was confirmed by bedside echocardiography. In five of eight VV-ECMO (62%) patients, circulatory arrest ensued and immediate VA-ECMO conversion was performed. Definitive treatment of cardiac tamponade consisted of surgical pericardiotomy in 10 cases: sternotomy (n=8), left minithoracotomy (n=1) and subxiphoid approach (n=1); and pericardiocentesis in one patient. Cardiovascular perforation repair was performed in five patients: two right atrium, two superior vena cava and one pulmonary artery. In the remaining six patients, cardiac tamponade was associated with recent cardiac surgery (n=2), prolonged cardiopulmonary resuscitation (n=1), thoracic trauma (n=1), myopericarditis (n=1), and acute myocardial infarction (n=1). Nine (9) patients (82%) were weaned from ECMO (20 days [range, 11-25]) and eight patients (73%) survived intensive care unit (ICU) (29 days [range, 26-61]) and hospital (34 days [range, 29-81]). Cardiac tamponade is a rare but life-threatening complication during both VV-ECMO and VA-ECMO. Echocardiography plays a major role in timely diagnosis and treatment. Immediate conversion to VA-ECMO when circulatory collapse ensued and emergency sternotomy for cardiovascular perforation repair gave favourable outcomes in a high proportion of patients.

224 Malignancy associated pericardial effusion- do we need to drain them all?

Abstract On Behalf Cardiac Team, Department of Medicine, Queen Elizabeth Hospital Background Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown. Purpose To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect. Methods From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage. Results 101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality. Conclusion Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect. Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 &amp;lt;0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593 Abstract 224 Figure. Survival free from drainage

Management of neoplastic pericardial disease.

At present, there is no accurate and effective method for treating neoplastic pericardial effusion. This study analyzed the current literature on the treatment of neoplastic pericardial effusion to provide advice and guidance for clinical treatment. Surgical treatments include pericardial puncture, extension of catheter drainage, pericardial window, and surgical pericardiotomy. Each surgical procedure has acorresponding indication, and the best treatment is selected according to the patient's specific conditions. Systemic chemotherapy is effective in lymphoma and small cell lung cancer that are sensitive to chemotherapeutic drugs. Although pericardial injection of drugs is effective for pericardial tamponade and recurrent pericardial effusion, these methods can only temporarily relieve symptoms and cannot prolong the life of patients. In recent years, immunotherapy, especially adoptive immunotherapy, has achieved good results in the treatment of neoplastic pericardial effusion, thus providing anovel treatment option for neoplastic pericardial effusion.

Coronary Perforation of Distal Diagonal Branch Followed by Prolonged Recurrent Cardiac Tamponade Finally Resolved with Pericardiotomy - the Potential Risk of Hydrophilic Guide-Wires.

Purpose:Coronary artery perforation (CAP) is a complication of percutaneous coronary interventions (PCIs). Hydrophilic guide-wires have been shown to increase the probability of CAP. Depending on the size of perforations we adopt different treatments.Case:We present the case of a 73-year old male with coronary artery disease and severe aortic valve stenosis. The patient was in the process of qualifying for a transcatheter aortic valve implantation. Unfortunately, CAP of the first diagonal branch of the LAD occurred during PCI. Initially, abrupt bleeding to the pericardial sac was primarily restrained. However, in the following days, pericardial bleeding became silent, prolonged and finally resulted in surgical pericardiotomy and surgical aortic valve replacement.Conclusion:This case depicts that in some cases, more aggressive endovascular treatment of CAP during the acute phase could decrease the probability of future radical surgical treatment. Although, in other cases, avoiding radical endovascular treatment of CAP and secondary necrosis along the distribution of the artery culminates in a higher risk for conversion to a surgical cardiac procedure. Accurate primary assessment of CAP seriousness and careful observation after PCI could improve results and lead to avoiding severe complications.

Surgical management of cardiac tamponade: Is left anterior minithoracotomy really safe and effective?

Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based techniques to surgical pericardiotomy. The Authors report their experience in surgical management of cardiac tamponade and an exhaustive review of literature. Methods: This study involved 61 patients (37 males and 24 females) with an average age of 61.80 ± 16.32 years. All patients underwent emergency surgery due to the presence of cardiac tamponade. Results: Cardiac tamponade was caused by a benign disease in 57.40% of patients. In cancer patients group, lung cancer, breast cancer and malignant pleural mesothelioma were the most common neoplasms (17-27, 87%). The average preoperative size of pericardial effusion at M-2D echocardiography was 30.15 ± 5.87 mm. Postoperative complications were observed in 11 patients (18%). The reoperation rate was 3.3% (2 patients) due to relapsed cardiac tamponade. 30-day mortality rate was 3.3%. Overall cumulative survival was 29.9 ± 20.1 months. Twenty-nine patients (47.5%) died during the follow up period. By dividing the population into two groups, group B (benign) and group M (malignant), there was a statistically significant difference (P < 0.001) in terms of survival. Conclusion: In conclusions, anterior minithoracotomy for surgical treatment of cardiac tamponade has to be held into account in patients both with benign diseases and malignancies.

Survival after surgical drainage of malignant pericardial effusion.

Management of malignant pericardial effusion (PE) is complex. Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients. Patients undergoing a surgical pericardiotomy for malignant PE, between 2001 and 2011, were included. The influence of tumor type, disease extension, intra-pericardial tumor infiltration on early mortality and long-term survival as well as freedom from symptoms after drainage, and the use of sclerosing agents on PE recurrence rates was analyzed. PE drainage was performed on 46 patients 12 ± 30 months after tumor diagnosis. Malignant diseases were lung cancers (50 %), breast cancers (15 %), lymphoma and leukemia (13 %), cancers of the digestive tract (13 %), and others (9 %). 80 % of patients were symptomatic and symptom relief was achieved in 65 %. Nobody died during surgery. Recurrence rate was 4 %. Early in-hospital mortality was 22 %. After 1 year, 29 % of patients were alive. Eleven patients (24 %) had a complete tumor regression. Metastatic spread (p < 0.001), pericardial infiltration (p = 0.02), and intra-pericardial Bleomycin (p = 0.01) injection were associated with increased mortality. Hematological malignancies had a better prognosis for survival. Surgical pericardiotomy is safe, associated with a low recurrence rate and symptom relief in the majority of dyspneic patients. Intra-pericardial Bleomycin may reduce recurrent effusion but does not ameliorate survival. Long-term survival rate was low with an increased mortality in cases of metastatic spreading, pericardial infiltration, and as the tumor of origin: breast cancers. Leukemic and lymphatic tumors have better prognosis.

Early and long-term outcomes of pericardiotomy in the treatment of primary cardiac tamponade.

IntroductionCardiac tamponade is a life-threatening clinical entity that requires emergent treatment. A variety of therapeutic methods have been applied. The purpose of this retrospective analysis was to study the efficacy of emergent surgical pericardiotomy in both the relief of cardiac tamponade and in the prevention of recurrence of pericardial effusion.Material and methodsThis study involved 90 consecutive patients (58 males and 32 females) with a mean age of 57.4 ± 14.1 years, who underwent emergent pericardiotomy in the years 2006 to 2011 due to symptomatic primary cardiac tamponade. At the end of the follow-up period all living subjects had control echocardiographic examination. Survival analysis was performed with the use of the Kaplan-Meier method.ResultsThe mean duration time of surgery was 14.2 ± 4.5 minutes. All patients survived surgery but one died during in-hospital stay. During the post-discharge follow-up period (median 49 months) 32 patients died for any reason. One-year and four-year probability of survival was 0.68 ± 0.05 and 0.64 ± 0.05, respectively. Malignancy diagnosis was associated with significant negative impact on survival. One-year and four-year probability of survival was 0.56 ± 0.06 and 0.53 ± 0.06 for cancer patients while it was 0.93 ± 0.05 and 0.89 ± 0.06 for the others, respectively. In two cases, only cancer patients, re-intervention due to effusion recurrence was necessary.ConclusionsPericardiotomy, although invasive, is a safe method to relieve cardiac tamponade. It is also very efficient in the prevention of recurrence of pericardial effusion, even in cancer patients.

Fibrin Sealant Patch to Treat Dialysis-Associated Hemorrhagic Pericarditis

A 73-year-old male patient with a 3-year history of hemodialysis was admitted for the treatment of pericardial effusion. Echocardiography suggested a diagnosis of effusive pericarditis. Pericardiocentesis was performed several times. Six weeks after the admission, the patient developed cardiac tamponade. Surgical pericardiotomy showed the epicardium had a diffuse shaggy and hemorrhagic surface. To control diffuse oozing, fibrin sealant patches (Tachosil; CSL Behring, Tokyo, Japan) were attached to the epicardium. Oozing was then controlled.

Implantation of Lung Cancer along the Tube Tract after Pericardiotomy for Malignant Pericardial Effusion: A Case Report

Surgical pericardiotomy is an effective method to treat malignant pericardial effusion. Although pericardiotomy is generally considered safe, it has its risk of complications, including hemothorax, arrhythmia, hypotension, or heart failure (1). Metastatic tumor seeding along a transient indwelling drainage tube is an extremely rare complication of pericardiotomy. To our knowledge, no such case has ever been reported. We present a case of tumor implantation along the pericardiomtomy tube tract in a patient with lung cancer.

Retrospective Comparison of Outcomes, Diagnostic Value, and Complications of Percutaneous Prolonged Drainage Versus Surgical Pericardiotomy of Pericardial Effusion Associated With Malignancy

Surgical pericardiotomy is often preferred as a primary option in patients with malignant pericardial effusions. Recent series have revealed that prolonged drainage substantially reduces pericardial effusion recurrence rates, even in the setting of malignancy. The aim of the study was to directly compare the efficacy of pericardiocentesis with prolonged drainage with the primary surgical pericardiotomy in patients with symptomatic pericardial effusion associated with a malignancy. We retrospectively evaluated 88 patients who presented with pericardial tamponade associated with a malignancy. Pericardiocentesis with extended drainage was performed in 43 patients and surgical pericardiotomy in 45 patients. The recurrence rate was not significantly different in patients with prolonged catheter drainage versus surgical pericardiotomy (12% vs 13%, respectively, p= 0.78). In addition, there was no significant difference in diagnostic yield between percutaneous drainage and surgical window (44% vs 53%, respectively, p= 0.39). The overall rate of complications was significantly lower in the prolonged drainage group (2% vs 20%, p= 0.007). Moreover, there were no serious complications in the prolonged drainage group versus 9% in the surgical pericardiotomy group. In conclusion, (1) surgical pericardiotomy with pericardial biopsy does not add significant diagnostic value beyond the cytologic assessment available with pericardiocentesis, (2) surgical pericardiotomy does not improve clinical outcomes over pericardiocentesis, and (3) surgical pericardiotomy is associated with a higher rate of complications.

COMPARATIVE OUTCOMES OF PERICARDIOCENTESIS VERSUS SURGICAL PERICARDIOTOMY IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND PERICARDIAL EFFUSION IN THE UNITED STATES

At this time, the comparative in-hospital outcomes for pericardiocentesis and surgical pericardiotomy (pericardial window) in patients with chronic kidney disease (CKD) and pericardial effusion are unknown. The Nationwide Inpatient Sample (NIS) was used to identify patients with CKD who underwent

An extremely rare combination: pneumopericardium, pneumoperitoneum, and subcutanous emphysema-a case report.

Pneumopericardium, an accumulation of air in the pericardial cavity, occurs very rarely as compared to pneumothorax and pneumomediastinum. Clinical presentation is variable, patients are frequently asymptomatic, and mild cases usually resolve spontaneously. However, it may lead to pericardial tamponade, which requires rapid diagnosis and treatment that can be lifesaving. The traditional diagnostic, simple method of diagnosis is via an upright chest X-ray. Typical findings can be detected and a differential diagnosis can be made between pneumomediastinum and pneumopericardium. Echocardiography and chest computed tomography scans can also support the diagnosis. Only one case of pneumopericardium after surgical pericardiotomy has been reported in the literature so far. In this case report, iatrogenic pneumopericardium, which resolved spontaneously after surgical pericardiotomy, was reported in a 19-year-old patient who had a rejected liver transplantation, and had liver and kidney failure with pericardial tamponade. In this case, pneumopericardium was accompanied by pneumoperitoneum and subcutaneous emphysema; an extremely rare combination.

Abstract 19557: Comparative In-Hospital Outcomes for Pericardiocentesis versus Surgical Pericardiotomy in United States

Background: The national and comparative in-hospital outcomes and resource utilization for pericardiocentesis and surgical pericardiotomy are not known. Methods: The Nationwide Inpatient Sample (NIS) database was used to identify patients who underwent pericardiocentesis or pericardiotomy from 2005 to 2009 in the United States. We used propensity score matching and the Elixhauser index for comorbidity adjustment to compare in-hospital outcomes and resource utilization among matched groups of patients that underwent either pericardiocentesis or pericardiotomy. Results: Among a total of 131,945 patients who underwent either procedure during the study period, 17,565 patients were divided into two matched groups of pericardiocentesis (9,336 patients) and pericardiotomy (8,229 patients). The pericardiocentesis group had significantly higher in-hospital mortality than the pericardiotomy group (15.7% vs. 10.4%, p&lt;0.001). Patients in the pericardiotomy group had a significantly higher rate of blood transfusions (22.6% vs. 19.5%, p&lt;0.001), post-procedural respiratory complications (2.0% vs. 0.8%, p&lt;0.001), iatrogenic pneumothorax (8.1% vs. 3.1%, p&lt;0.001), post-operative hemorrhage (3.1% vs. 1.8%, p&lt;0.001), and post-operative hematoma (1.5% vs. 1.0%, p=0.001). The average length of stay was longer in the pericardiotomy group than in the pericardiocentesis group (12.6 vs. 8.5 days, p &lt;0.001). The average hospital charges were also higher in the pericardiotomy group than in the pericardiocentesis group ($108,624 vs. $75,690, p&lt;0.001). Conclusion: In this observational study, we found that pericardiocentesis is associated with a significantly higher in-hospital mortality than surgical pericardiotomy while the latter is associated with higher rates of post-operative morbidity and resource utilization.

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

Malignant disease with pericardial metastasis is one of the most common causes of recurrent pericardial effusion (PE) with tamponade. While surgical pericardiotomy in these patients is very morbid and may not be a viable option, a palliative treatment percutaneously with percutaneous balloon pericardiotomy (PBP) can be a preferred treatment. We report herewith a case of PBP technique done using our day-to-day catheterisation laboratory equipment.

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

Malignant disease with pericardial metastasis is one of the most common causes of recurrent pericardial effusion (PE) with tamponade. While surgical pericardiotomy in these patients is very morbid and may not be a viable option, a palliative treatment percutaneously with percutaneous balloon pericardiotomy (PBP) can be a preferred treatment. We report herewith a case of PBP technique done using our day-to-day catheterisation laboratory equipment.

Management Strategies in Pericardial Emergencies

The most frequent pericardial emergency is cardiac tamponade, but complications of an acute coronary syndrome and aortic dissection may also involve the pericardium. Acute pericarditis can also represent a medical emergency due to chest pain of upsetting intensity. Decompensations in chronic advanced constriction and in the clinical course of purulent pericarditis necessitate critical care as well. The diagnosis of cardiac tamponade is based on clinical presentation and physical findings, confirmed by echocardiography and cardiac catheterization. Tamponade is an absolute indication for urgent drainage, either by pericardiocentesis or surgical pericardiotomy. The approach for pericardiocentesis can be subxiphoid or intercostal using echocardiographic or fluoroscopic guidance. Urgent drainage, combined with intravenous antibiotics, is also mandatory in suspected purulent pericarditis. If confirmed, it should be combined with intrapericardial rinsing (best by a surgical drainage). Pericardiocentesis is contraindicated in cardiac tamponade complicating aortic dissection. This condition should immediately lead to cardiac surgery. Although pericardiectomy is the only treatment for permanent constriction, this procedure is contraindicated when extensive myocardial fibrosis and/or atrophy are demonstrated. Iatrogenic tamponade may occur during percutaneous mitral valvuloplasty, implantation of pacemakers, electrophysiology and radiofrequency ablation procedures, right ventricular endomyocardial biopsy, percutaneous coronary interventions, and rarely during Swan-Ganz catheterization. The authors report on a 79-year-old who suffered coronary perforation and cardiac tamponade during elective stent implantation. Tamponade was successfully treated with pericardiocentesis and implantation of a membrane-covered graft stent. Subsequent recurrent pericarditis/postpericardial injury syndrome with moderate pericardial effusion was initially treated with aspirin and then with aspirin and colchicine. At 6 months, the patient is in stable remission even after withdrawal of colchicine. Natural history of pericardial diseases can be complicated with pericardial emergencies requiring prompt diagnosis, intensive care with hemodynamic monitoring, and early aggressive management. Medical supportive measures, drainage of pericardial effusion, surgical pericardiotomy, and pericardiectomy should be applied when needed with no delay. This procedural approach also applies to iatrogenic interventions leading to tamponade.