Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

Prevention of cardiac tamponade by left intercostal Pericardiotomy for massive recurrent pericardial effusion: a case report

This case involved an 89-year-old woman with a history of left nephrectomy for left renal cell carcinoma at the age of 87 years. She had been gradually accumulating pericardial effusion for the past 4 years. She presented with signs of tachycardia and hypotension suggestive of cardiac tamponade due to pericardial effusion, and pericardiocentesis was performed below the xiphoid process in the cardiology department. Serous fluid was aspirated, and malignancy was ruled out by various tests. The patient subsequently developed recurrent pericardial effusion and was admitted to the hospital. Cardiovascular surgery was performed for pericardial drainage. A left intercostal incision was made for pericardiotomy and drainage of the pericardial effusion, allowing it to accumulate in the left pleural cavity in case of future accumulation. Pathological examination of the pericardium revealed no specific findings, and no cancer cells were present in the pericardial fluid. Prednisolone therapy was initiated for idiopathic pericarditis.

Epidemiology of pericardial diseases in Africa: a systematic scoping review

OBJECTIVES

This scoping review sought to summarise available data on the prevalence, aetiology, diagnosis, treatment and outcome of pericardial disease in Africa.

METHODS

We searched PubMed, Scopus and African Journals Online from 1 January 1967 to 30 July 2017 to identify all studies published on the prevalence, aetiologies, diagnosis, treatment and outcomes of pericardial diseases in adults residing in Africa.

RESULTS

36 studies were included. The prevalence of pericardial diseases varies widely according to the population of interest: about 1.1% among people with cardiac complaints, between 3.3% and 6.8% among two large cohorts of patients with heart failure and up to 46.5% in an HIV-infected population with cardiac symptoms. Tuberculosis is the most frequent cause of pericardial diseases in both HIV-uninfected and HIV-infected populations. Patients with tuberculous pericarditis present mostly with effusive pericarditis (79.5%), effusive constrictive pericarditis (15.1%) and myopericarditis (13%); a large proportion of them (up to 20%) present in cardiac tamponade. The aetiological diagnosis of pericardial diseases is challenging in African resource-limited settings, especially for tuberculous pericarditis for which the diagnosis is not definite in many cases. The outcome of these diseases remains poor, with mortality rates between 18% and 25% despite seemingly appropriate treatment approaches. Mortality is highest among patients with tuberculous pericarditis especially those coinfected with HIV.

CONCLUSION

Pericardial diseases are a significant cause of morbidity and mortality in Africa, especially in HIV-infected individuals. Tuberculosis is the most frequent cause of pericardial diseases, and it is associated with poor outcomes.