Uremic Pericardial Effusion Research Articles

Percutaneous pericardial catheter drainage for symptomatic uremic pericardial effusions with narrow safety margins.

Percutaneous pericardial catheter drainage (PCD) for pericardial effusion is generally known to be limited by the high risk associated with effusions that are less than 10 mm thick. The objective was to report cases who underwent percutaneous PCD for symptomatic uremic pericardial effusions, which were less than 10 mm thick after cardiologist declined to perform the PCDs because of the narrow safety margins. Thirteen consecutive cases (11 patients) (median age, 56 years, range, 31-83) with symptomatic uremic pericardial effusion (thickness <10 mm) affecting the pericardial space anterior to the right ventricle underwent ultrasound- and fluoroscopy-guided percutaneous PCD between September 2015 and April 2022. Information regarding the clinical criteria, echocardiographic features, PCD details, nature of effusion, and outcomes, including success and complications were retrospectively evaluated. Pigtail catheter (8.5-Fr) insertion was successful for all patients, with a median procedure time of 7 minutes (range 4~12) without procedure-related complications. The median amount of drainage on the day of PCD was 700 mL (range, 250-1100). The median duration of catheter indwelling was 5 days (range, 1~32). In one case, the catheter was removed after 1 day due to chest pain. For all patients, pericardial effusion evacuation was achieved with relief of associated symptoms, representing 100% clinical success. Percutaneous PCD may be safely performed for patients with symptomatic uremic pericardial effusions and narrow safety margins of less than 10 mm.

Predisposing factors and uremic pericardial effusion among ESRD patients undergoing dialysis

ObjectivePericardial effusion and pericarditis are responsible for 3–5% of deaths due to tamponade, fatal arrhythmia and heart failure. Improvement in dialysis methods has allowed the initiation of the treatment at early stages. This study is designed to evaluate the prevalence of pericardial effusion and its predisposing factors among end-stage renal disease (ESRD) patients undergoing dialysis. MethodsThis is a cross-sectional study that included patients from the two Medical Centers in (XXX). These patients were presented with ESRD with a GFR <10 cc/min and were under long-term dialysis, also called chronic hemodialysis. The echocardiography was performed and patients with pericarditis and/or pericardial effusion due to non-uremic causes or dialysis were excluded. ResultsOf 132 patients included, mild pericardial effusion was observed in 17(12.9%) patients, 8(6.1%) patients were presented with moderate and 1 (0.7%) had severe pericardial effusion. Among females, 9(15.8%) showed pericardial effusion whereas, it was reported in 8(10.7%) males, with no statistically significant difference. Furthermore, no significant difference was seen in the ages or etiologies of patients with or without pericardial effusion (50.5 ± 15.5 vs 52.8 ± 16.1, respectively). ConclusionOur study reports that echocardiography among dialysis patients is likely to determine the effectiveness of the dialysis procedure and can be a cost-effective approach. Futher studies regarding laboratory parameters are required in this area.

Serious Combination of Chronic Non Tamponade Uremic Pericardial Effusion, Hypotension, and Atrial Fibrillation on Living Donor Renal Transplantation: A Case Report and Review of Literature

Although pericardial effusions are not uncommon in patients with end-stage renal disease, uremic pericardial effusion (UPE) frequently remains unrecognized in the absence of clinical signs and symptoms. We present a case of post-living donor renal transplantation delayed graft function due to asymptomatic undiagnosed chronic nontamponade UPE. The patient developed dramatic intraoperative severe hypotension, electrolyte abnormalities, and atrial fibrillation. Prolonged intraoperative hypotension and allograft hypoperfusion caused mild acute tubular necrosis and postoperative delayed graft function that required 2 weeks to recover. The combination of chronic UPE, even without tamponade, hypotension, and atrial fibrillation could lead to significant hemodynamic instability during renal transplantation. More careful immediate pretransplantation cardiac evaluation and avoidance of intraoperative hypotension could prevent these serious consequences of silent UPE.s.

Symptomatic Childhood Uremic Pericardial Effusion: An Echocardiography Image

Large childhood symptomatic pericardial effusion demanding pericardio-centesis and pericardial drainage is rare and symptomatic childhood uremic pericardial effusion is even rarer. The aim of this paper is to report the rare occurrence of childhood uremic symptomatic pericardial effusion. A seven year old boy with the most extreme form of end-stage renal disease (anuric with no renal function). The patient developed large childhood symptomatic pericardial effusion which was diagnosed by echocardiography.

Symptomatic Childhood Uremic Pericardial Effusion: An Echocardiography Image.

Large childhood symptomatic pericardial effusion demanding pericardiocentesis and pericardial drainage is rare and symptomatic childhood uremic pericardial effusion is even rarer. The aim of this paper is to report the rare occurrence of childhood uremic symptomatic pericardial effusion. A seven-year-old boy with the most extreme form of end-stage renal disease (anuric with no renal function). The patient developed large childhood symptomatic pericardial effusion which was diagnosed by echocardiography.

Symptomatic Childhood Uremic Pericardial Effusion: An Echocardiography Image

Symptomatic Childhood Uremic Pericardial Effusion: An Echocardiography Image

Wide QRS Tachycardia in a Dual Chamber Pacemaker Patient: What is the Mechanism?

A 67-year-old man with a DDD pacemaker for complete atrioventricular block had dyspnea with cardiomegaly on a chest radiogram. Additionally, he had atrial fibrillation, which was well controlled with a class Ic antiarrhythmic agent. He had chronic kidney disease; therefore, uremic pericardial effusion was highly suspected, and pericardiostomy was performed. During surgery, the pacemaker mode was temporarily set to DOO to avoid electrical interference. After surgery, dyspnea was relieved, but it recurred 2 days later without aggravated pericardial effusion. An electrocardiogram showed wide QRS tachycardia at 150 beats per minute. What is the mechanism?

Importance of urgent surgical treatment in a patient having massive pericardial effusion with end-stage renal disease

Results Subxiphoid pericardial drainage was performed under local anesthesia. Pericardial fluid of 1000 ml was drained. A pericardial drainage tube was inserted at surgery and removed after 5 days. A 2 x 3 cm2 biopsy specimen was taken under direct vision from the lower aspect of anterior pericardium. Sample of the drained fluid was collected for microbiological culture and cytological analysis. Microorganism cultured no from pericardial fluid. The pericardial biopsy specimen was negative for malignancy. He has uremic pericardial effusion. There was no complication and surgery-related death. After hospital discharge, patient was followed with physical examinations and echocardiogram.

Hemorrhagic cardiac tamponade in critically ill patients with acute renal failure

Purpose The purpose of this study was to report the development, management, and follow up of tamponading uremic pericardial effusion in critically ill patients with acute renal failure. Setting The setting for this study was an adult, 24-bed tertiary multidisciplinary intensive care unit (ICU) of a university hospital. Patients The subjects were 5 critically ill patients with multiple organ failure including acute renal failure (ARF) that was slow to resolve. Results Renal involvement was attributed to renal hypoperfusion, sepsis and myoglobinuria. Continuous veno-venous hemofiltration (CVVH) was instituted early during hospitalization in 4 cases and lasted for 35 to 48 days; renal replacement therapy was not used in 1 case. Tamponade developed late in the course of ARF, after CVVH was discontinued in the 4 cases and was effectively managed with percutaneous pericardiocentesis under echocardiography and continuous catheter drainage of the pericardial sac for 48 to 72 hours. Hemorrhagic fluid (Hb 2.2-5.9 g/dL) with lymphocyte predominance was detected. Transient constrictive-like pericarditis findings were present in all patients after the procedure. All patients were discharged from the hospital in a good condition with normal serum and creatinine levels; 1-year follow up showed a normal echocardiogram. Conclusion Awareness for the possibility of hemorrhagic pericarditis and cardiac tamponade is needed in ICU patients with ARF slow to resolve. Transient constrictive-like pericarditis may present after pericardiocentesis.

Adult Still's Disease Complicated by Cardiac Tamponade

To the Editor.— In Dr Jamieson's report, Adult Still's Disease Complicated by Cardiac Tamponade, no mention is made of the possibility of treatment of this manifestation of the disease with pericardiocentesis and local corticosteroid injection rather than with systemic corticosteroids. Treatment of uremic pericardial effusion with local steroid instillation was first reported by Buselmeier in 1973 and summarized in an expanded report in 1978. 1 A large series was also described by Fuller, 2 and successful applications of this technique to both children and adults with tamponade caused by rheumatoid pericarditis were subsequently reported by four other groups. 3-6 Prolonged daily administration of systemic steroids may be avoided in at least some patients with rheumatoid pericarditis and tamponade (provided they do not have sufficient concurrent myocarditis to require systemic therapy), and this mode of therapy should be considered for patients such as Dr Jamieson's.

Serum Calcium in Blood Pressure Regulation During Hemodialysis

Frequent hypotensive episodes developed in a 56-year-old man, who was receiving long-term hemodialysis therapy, at the time he had a uremic pericardial effusion. During dialysis with an inadvertent calcium infusion, however, the mean blood pressure (BP) was sustained and even rose from 93 to 133 mm Hg. During continued dialysis to restore the serum calcium level from a peak of 17.4 to 12.0 mg/dL, mean arterial pressure decreased back to 93 mm Hg. In contrast, BP had fallen in three of six preceding dialysis treatments and five of nine subsequent dialysis treatments, all at the same ultrafiltration rate. This report suggests the importance of serum calcium to BP regulation during hemodialysis.

Treatment of uremic pericardial effusion by local steroid instillation via subxiphoid pericardiotomy.

Seven maintenance hemodialysis patients suffering from intractable uremic pericardial effusion were treated with instillation of a non-absorbable steroid, triamcinolone hexacetonide, into the pericardial sac via a large-bore catheter. The latter was placed under direct vision by subxiphoid pericardiotomy. All patients responded to the treatment while complications of the procedure were few and minor.

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Echocardiographic Diagnosis, Classification, and Dialysis Treatment of Uremic Pericardial Effusion

Treatment of Intractable Uremic Pericardial Effusion

Forty-five patients with uremic pericardial effusion were treated with local instillation of nonabsorbable steroid through an indwelling pericardial drainage catheter and followed up from one to 54 months. In these patients previous intensive dialysis and other attempts at control of the effusions were unsuccessful. The average hospitalization for percutaneous therapy was eight days. An asymptomatic internal mammary artery fistula developed in one patient. Another had resolution of her pericardial effusion but not of associated pericardial pain. She subsequently underwent pericardiectomy (stripping), without resolution of her pain. One patient had a recurrence of her effusion six months after therapy. Complications of this technique are rare. The relatively noninvasive drainage and local instillation of a nonabsorbable steroid is almost universally effective.

Treatment of intractable uremic pericardial effusion. Avoidance of pericardiectomy with local steroid instillation

Treatment of intractable uremic pericardial effusion. Avoidance of pericardiectomy with local steroid instillation

Intraperitoneal infusion of a nonabsorbable steroid in hemodialysis-associated ascites.

Ascites occurring in long-term hemodialysis patients continues to be a difficult management problem. Several modalities have been employed with varying success. Because of the similarities between uremic pericardial effusion and hemodialysis-associated ascites, infusion of the nonabsorbable steroid, triamcinolone hexacetonide, was attempted in five patients with the latter ailment which had become intractable. None of the patients responded and in two there were adverse effects. We conclude that for the management of this variety of ascites, intraperitoneal administration of a nonabsorbable steroid is ineffective and may be accompanied by undesirable reactions.

Pericardial drainage operations in the management of uremic pericardial effusion

Because of frequent failures in nonoperative therapy, we have adopted early surgical drainage of the pericardium in the management of uremic pericardial effusion. This series presents the longest follow-up period of any group of patients with uremic pericardial effusion treated by surgical drainage. There have been no intraoperative deaths and no recurrences. The total hospital mortality rate was 8.3 per cent and the late mortality rate over a 72 month period was 25 per cent. Internal pericardiostomy drainage is a simple yet effective surgical solution to the life-threatening problem of uremic pericardial effusion.

Anesthetic considerations for pericardectomy in uremic pericardial effusion.

Fifteen patients with impending uremic cardiac tamponade underwent either anterior pericardectomy or pericardiostomy under general anesthesia. Anesthetic agents and technics were selected in the light of physiopathologic derangements involving fluids and electrolyte balance, excretory and cardiovascular disturbances, and pharmacodynamics. Anesthesia was induced with diazepam and maintained with N2O-O2 (70:30) and fentanyl. Pancuronium was used for muscle relaxation. Adequate preoperative assessment of patient, careful monitoring of vital signs, maintenance of the critical balance of fluid and blood replacement, and selection of anesthetic agents for minimal depression of vital multiorgan systems provided excellent results. No postanesthetic morbidity or mortality occurred.