Twenty-two patients with malignant pericardial effusions were treated with subxiphoid partial pericardiectomy between 1984 and 1989. Thirteen patients also had a sclerosing agent instilled intrapericardially. Tamponade was relieved by pericardiocentesis before administration of general anesthesia. In 18 patients (82%), the effusions were controlled for longer than 30 days, and two patients died before 30 days without effusion. There were two recurrences at 1.5 and 7 months. There was one death due to hemorrhage from a laceration in a heavily infiltrated pericardium, and one patient had persistent dyspnea after the procedure. Complications included transient atrial arrhythmias (two patients), chest pain after sclerosant instillation (three patients), and fever greater than 37.5'C after sclerosant (five patients). The survival range was 0.1 to 18 months (median, 5 months). Subxiphoid partial pericardiectomy with or without intrapericardial sclerosant is a safe and efficacious treatment for malignant pericardial effusions. Cancer 681021-1025.1991.
ERICARDIAL AND CARDIAC METASTASES were re-P ported in up to 21% of patients with cancer in a multiple autopsy series. I Clinically significant pericardial effusions occur much less commonly but require early recognition and treatment because cardiac tamponade is a potentially fatal complication. Treatment methods include partial pericardiectomy through subxiphoid or anterior thoracotomy approaches,2-6 pericardiocentesis followed by intrapericardial sclerosing agent, e.g., tetracypericardial radiation therapy,' and pericardiocentesis followed by systemic therapy." Most recent reports recommend either subxiphoid partial peri~ardiectorny~.~.~, ' I or tetracycline s c l e r o ~i s . ~~~ We describe our experience with subxiphoid partial pericardiectomy in patients with symptomatic malignant pericardial effusions (MPE) treated in a single institution over a 5.5-year period. A subset of patients also received intrapericardial sclerosant therapy.