Outcomes of idiopathic chronic large pericardial effusion.

OBJECTIVE: Aim of this paper is to evaluate the outcomes of 'idiopathic' chronic large pericardial effusions without initial evidence of pericarditis. METHODS: All consecutive cases of idiopathic chronic large pericardial effusions evaluated from 2000 to 2015 in three Italian tertiary referral centres for pericardial diseases were enrolled in a prospective cohort study. The term 'idiopathic' was applied to cases that performed a complete diagnostic evaluation to exclude a specific aetiology. A clinical and echocardiographic follow-up was performed every 3-6 months. RESULTS: 100 patients were included (mean age 61.3±14.6 years, 54 females, 44 patients were asymptomatic according to clinical evaluation) with a mean follow-up of 50 months. The baseline median size of the effusion (evaluated as the largest end-diastolic echo-free space) was 25 mm (IQR 8) and decreased to a mean value of 7 mm (IQR 19; p<0.0001) with complete regression in 39 patients at the end of follow-up. There were no new aetiological diagnoses. Adverse events were respectively: cardiac tamponade in 8 patients (8.0%), pericardiocentesis in 30 patients (30.0%), pericardial window in 12 cases (12.0%) and pericardiectomy in 3 patients (3.0%). Recurrence-free survival and complications-free survival was better in patients treated without interventions (log rank p=0.0038). CONCLUSIONS: The evolution of 'idiopathic' chronic large pericardial effusions is usually benign with reduction of the size of the effusion in the majority of cases, and regression in about 40% of cases. The risk of cardiac tamponade is 2.2%/year and recurrence/complications survival was better in patients treated conservatively without interventions.

Administrative billing codes accurately identified occurrence of electrical cardioversion and ablation/maze procedures in a prospective cohort study of atrial fibrillation patients.

BACKGROUND: Administrative billing codes for electrical cardioversion and ablation/maze procedures may be useful for atrial fibrillation (AF) research if the codes are accurate relative to medical record documentation. HYPOTHESIS: Administrative billing codes accurately identify occurrence of electrical cardioversion and ablation/maze procedures in AF patients. METHODS: We studied adults ages 30 to 84 who experienced new-onset AF between October 2001 and December 2004 in Group Health Cooperative (acquired by Kaiser Permanente in 2017), an integrated healthcare system in Washington state and northern Idaho. Using medical record review as the gold standard, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for 3 administrative billing codes for electrical cardioversion and 3 codes for AF ablation/maze procedures. RESULTS: Of 1953 study participants, during a mean (SD) of 1.5 (0.7) years of follow-up after AF onset, 470 (24%) experienced electrical cardioversion and 44 (2%) experienced ablation/maze procedures, according to medical record review. For electrical cardioversion, individual codes had 7.7% to 76.4% sensitivity, >99% specificity, 83.7% to 96.5% PPV, and 77.3% to 93.0% NPV. Considering any of 3 codes (code 1 or code 2 or code 3) improved sensitivity to 84.9%. For ablation/maze, individual codes had 18.2% to 47.7% sensitivity, >99% specificity, 66.7% to 95.5% PPV, and >98% NPV. Considering any of 3 codes improved sensitivity to 84.1%. CONCLUSIONS: Administrative billing data accurately identified electrical cardioversion and ablation/maze procedures and can be used instead of medical record review. Our findings apply to healthcare settings with available administrative billing databases.

Results of pericardiectomy for constrictive pericarditis : Single-center experience.

BACKGROUND: We evaluated our early and late outcomes after pericardiectomy in patients with constrictive pericarditis (CP). PATIENTS AND METHODS: We retrospectively reviewed 31 patients who underwent pericardiectomy for CP from 1997 to 2015. Their mean age was 49.2 ± 18.5 years and 74.2 % of them were male. The vast majority had severe functional impairment (NYHA class III-IV) with a mean duration of symptoms of 14.2 ± 10.1 months. RESULTS: Early mortality was 9.7 %: n = 3; multiorgan failure (MOF) in 1, respiratory failure in 1, and left heart failure in 1. Preoperative systolic pulmonary artery pressure over 60 mmHg (p = 0.038, odds ratio [OR] = 0.12) and postoperative low cardiac output syndrome (p = 0.005, OR = 13.5) were significant predictors of early mortality in univariate analysis. Mean follow-up time was 57.8 ± 61.9 months (4-216 months). Late mortality was 6.8 % (2/28 patients) and the cause was MOF secondary to end-stage right heart failure. In Kaplan-Meier analyses, actuarial (including early mortality) and event-free survival rates were 83.9 and 51.1 % at 216 months, respectively. At the end of follow-up, the majority of patients (23/26, 92.9 %) were in good functional status (NYHA class I-II). There were fewer patients under diuretic therapy in the postoperative than in the preoperative period; however, the difference was not statistically significant (12/31 vs. 4/26, p = 0.76). There was no significant difference between the preoperative and follow-up tricuspid annular plane systolic excursion values (15.5 ± 2.2 and 16.6 ± 2.2 mm, respectively, p = 0.088). Left ventricular systolic function was preserved in all patients postoperatively. CONCLUSION: Although early mortality after pericardiectomy remains high, the procedure provides significant improvement in functional status in the long term.

Clinical Practice Patterns in Constrictive Pericarditis Patients With Heart Failure: A Retrospective Cohort Study Using a National Inpatient Database in Japan.

BACKGROUND: Previous studies on constrictive pericarditis (CP) mainly concerned patients undergoing pericardiectomy. The reported perioperative mortality of CP patients remained high. Data on medically treated CP patients without pericardiectomy have been scarce. HYPOTHESIS: Constrictive pericarditis patients with more comorbidities are less likely to undergo pericardiectomy. METHODS: Using the Diagnosis Procedure Combination database from 2007 to 2013, we retrospectively identified CP patients admitted with heart failure of New York Heart Association (NYHA) class II to IV. We compared clinical characteristics between patients treated with and without pericardiectomy. A multivariable logistic regression analysis was performed to assess the factors associated with likelihood of undergoing pericardiectomy. RESULTS: Of 855 eligible patients, 164 (19.2%) underwent pericardiectomy (surgery group) and 691 (80.8%) did not (no-surgery group). The surgery group was younger (mean age, 65.0 years vs 70.3 years; P < 0.001) and more often male (81.7% vs 72.2%; P = 0.013) than the no-surgery group. No significant difference was seen in NYHA class and Barthel Index between the groups, whereas the surgery group had a lower Charlson Comorbidity Index (CCI). Older age, female sex, and higher CCI were significantly associated with a lower likelihood of undergoing pericardiectomy. In the surgery group, 30-day postoperative mortality was significantly higher in patients who underwent cardiopulmonary bypass than in those who did not (11.3% vs 2.9%; P = 0.030). CONCLUSIONS: Patients' backgrounds were associated with the likelihood of undergoing pericardiectomy. Conservative medical therapy may be acceptable in CP patients with severe background and high preoperative need for cardiopulmonary bypass.

Pericarditis recurrente: ¿la anakinra puede aportar un tratamiento prometedor para adultos con síntomas refractarios? / Recurrent pericarditis: can anakinra offer a promising therapy in adults with refractory symptoms?

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Pericarditis recurrente: ¿la anakinra puede aportar un tratamiento prometedor para adultos con síntomas refractarios?. Respuesta / Recurrent pericarditis: can anakinra offer a promising therapy in adults with refractory symptoms?. Response

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Pericardiectomy vs medical management in patients with relapsing pericarditis.

OBJECTIVE: To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis. PATIENTS AND METHODS: Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use. RESULTS: Mean ± SD follow-up was 5.5 ± 3.5 years in the surgical group and 5.4 ± 4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1% [n=25] vs 18.3% [n=23]; P=.002) and corticosteroids (70.7% [n=41] vs 42.1% [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6% [n=16] vs 11.1% [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0%) and major morbidity (3%; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy. CONCLUSION: In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.

The use of posterior pericardiotomy technique to prevent postoperative pericardial effusion in cardiac surgery.

AIM: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT). MATERIALS AND METHODS: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded. RESULTS: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups. CONCLUSION: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

[Epidemiological analysis of pericardiotomies performed at a university hospital of Curitiba]. / Análise epidemiológica das pericardiotomias realizadas em um hospital universitário de Curitiba.

OBJECTIVE: Epidemiologically analyze the use of the pericardiostomy in the diagnosis of cardiac injury in a trauma universitary hospital in Curitiba. METHODS: Observacional, retrospective study, analyzing medical records of patients who were submitted to penetrating or blunt trauma, in a period of 06 years, in Urgency and Emergency unit of Cajuru Universitary Hospital. RESULTS: 120 patients had been submitted to pericardiostomy in the period above related. The age group varied from 15 to 80 years, the major prevalence between 20 and 30 years (49.7%), 105 patients were men and 15 women. Blunt trauma corresponded to 14 patients and penetrating to 105 patients. From penetrating ones, 41 patients were inflicted by stabwound, 60 by gunshot wound and 4 by both. About injury sites: 47.5% had been precordial, 34.16% in thoraco-abdominal transistion, 5.0% in both and 13.33% in other sites. From the accomplished JP, 72.5% had been negative and 27.5% positive. Among the positive, cardiac injuries diagnosed by immediate thoracotomy were: right atrium 21.2%, right ventricle 30.3%, left ventricle 24,2%, ascending aorta 3%, no injury 21.2%. 35 patients died: 18 of them up to 24hs and 17 after 24hs. CONCLUSION: The pericardiostomy were performed mostly in young men with penetrating trauma caused by gunshot wounds., in its majority with injury of the right ventricle as main finding, which agreed to the reviwed literature.

Análise epidemiológica das pericardiotomias realizadas em um hospital universitário de Curitiba / Epidemiological analysis of pericardiotomys held in a university hospital of Curitiba

OBJETIVO: Analisar epidemiologicamente a utilização da janela pericárdica(JP) no diagnóstico de lesão cardíaca em um hospital universitário de trauma de Curitiba. MÉTODOS: Estudo observacional, retrospectivo, de análise dos prontuários de pacientes que foram submetidos a pericardiotomia por trauma contuso ou penetrante, no período de seis anos, no serviço de Urgência e Emergência do Hospital Universitário Cajuru. RESULTADOS: 120 pacientes foram submetidos à Janela Pericárdica no período acima referido. A faixa etária variou de 15 a 80 anos, sendo a maior prevalência entre os 20 a 30 anos (49,7 por cento), 105(87,5 por cento) pacientes eram homens e 15(12,5 por cento) mulheres. Os traumas fechados foram 14(11,67 por cento) e penetrantes 105(87,5 por cento). Dos penetrantes, 41 foram por ferida de arma branca, 60 por ferida de arma de fogo e quatro por ambas. Quanto à localização das lesões: 47,5 por cento foram precordiais, 34,16 por cento em transição tóraco-abdominal, 5,0 por cento em ambas e 13,33 por cento em outras localizações. Das JP realizadas, 72,5 por cento foram negativas e 27,5 por cento positivas. Dentre as positivas, as lesões cardíacas encontradas foram: átrio direito 21,2 por cento, ventrículo direito 30,3 por cento, ventrículo esquerdo 24,2 por cento, aorta ascendente 3 por cento, nenhuma lesão 21,2 por cento. Houve 35 óbitos: 18 deles até 24hs e 17 após 24hs. CONCLUSÃO: A janela pericárdica foi mais realizada em homens jovens com ferimentos penetrantes por arma de fogo, em sua maioria com lesão do ventrículo direito como principal achado, concordando com a literatura revisada.

OBJECTIVE: Epidemiologically analyze the use of the pericardiostomy in the diagnosis of cardiac injury in a trauma universitary hospital in Curitiba. METHODS: Observacional, retrospective study, analyzing medical records of patients who were submitted to penetrating or blunt trauma, in a period of 06 years, in Urgency and Emergency unit of Cajuru Universitary Hospital. RESULTS: 120 patients had been submitted to pericardiostomy in the period above related. The age group varied from 15 to 80 years, the major prevalence between 20 and 30 years (49.7 percent), 105 patients were men and 15 women. Blunt trauma corresponded to 14 patients and penetrating to 105 patients. From penetrating ones, 41 patients were inflicted by stabwound, 60 by gunshot wound and 4 by both. About injury sites: 47.5 percent had been precordial, 34.16 percent in thoraco-abdominal transistion, 5.0 percent in both and 13.33 percent in other sites. From the accomplished JP, 72.5 percent had been negative and 27.5 percent positive. Among the positive, cardiac injuries diagnosed by immediate thoracotomy were: right atrium 21.2 percent, right ventricle 30.3 percent, left ventricle 24,2 percent, ascending aorta 3 percent, no injury 21.2 percent. 35 patients died: 18 of them up to 24hs and 17 after 24hs. CONCLUSION: The pericardiostomy were performed mostly in young men with penetrating trauma caused by gunshot wounds., in its majority with injury of the right ventricle as main finding, which agreed to the reviwed literature.

Postoperative pericardial effusion and posterior pericardiotomy, related or not?

INTRODUCTION: Large pericardial effusions after cardiac surgery develop in 30% of patients and reach their maximum size on approximately day 10 postoperatively. Tamponade develops in approximately 1% of patients with large pericardial effusions. Effusion may be prevented by posterior pericardiotomy, but its role and possible adverse consequences are controversial. We sought to further investigate the effectiveness of this technique. METHOD: This prospective randomized case-control study was carried out on 410 patients, mean age 68.4 +/- 9.2 years, who underwent coronary artery bypass graft surgery alone or combined with valve surgery during the period between April 2005 and May 2006. A 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve in the pericardiotomy group. Echocardiographic study was performed at the time of discharge and 15 and 30 days after surgery. RESULTS: After 15 and 30 days postsurgery, respectively, 178 (90.2%) and 192 (97%) of patients from the pericardiotomy group and none from the conventional group were free of effusion (P < .05). CONCLUSION: Posterior pericardiotomy is easy to perform and is a safe and effective means to prevent postoperative effusion and its early and delayed adverse consequences.

Opening the pericardium during pulmonary artery constriction improves cardiac function.

During acute pulmonary hypertension, both the pericardium and the right ventricle (RV) constrain left ventricular (LV) filling; therefore, pericardiotomy should improve LV function. LV, RV, and pericardial pressures and RV and LV dimensions and LV stroke volume (SV) were measured in six anesthetized dogs. The pericardium was closed, the chest was left open, and the lungs were held away from the heart. Data were collected at baseline, during pulmonary artery constriction (PAC), and after pericardiotomy with PAC maintained. PAC decreased SV by one-half. RV diameter increased, and septum-to-LV free wall diameter and LV area (our index of LV end-diastolic volume) decreased. Compared with during PAC, pericardiotomy increased LV area and SV increased 35%. LV and RV compliance (pressure-dimension relations) and LV contractility (stroke work-LV area relations) were unchanged. Although series interaction accounts for much of the decreased cardiac output during acute pulmonary hypertension, pericardial constraint and leftward septal shift are also important. Pericardiotomy can improve LV function in the absence of other sources of external constraint to LV filling.

Surgical pathology of the parietal pericardium: a study of 344 cases (1993-1999).

Among 344 cases with surgically resected parietal pericardium, ages ranged from 1 to 87 years (mean, 55), and 64% were male. Causes of pericardial disease included neoplastic (33%), idiopathic (30%), iatrogenic (23%), and others (14%). Pericardial constriction (Group 1) represented the largest group (143 cases, 76% male). Maximal pericardial thickness was 1-17 mm (mean, 4). Fibrotic thickening occurred in 96%. Chronic lymphoplasmacytic inflammation affected 73% (mild or moderate in 97%). Calcification was uncommon (gross in 28%, microscopic in 8%), and granulomas were rare (4%, none tubercular). Constriction was idiopathic in 49% and iatrogenic (postpericardiotomy or postirradiation) in 41%. Neoplasms and cysts (Group 2) represented the second largest group (96 cases). Among 43 cases with secondary pericardial involvement, carcinomas accounted for 53% and lymphomas 21%. Forty cases (Group 3) had pericardial effusions (75% chronic), which were idiopathic in 28% and postpericardiotomy in 23%. Thirty-three cases (Group 4) had acute or recurrent pericarditis clinically, which was idiopathic in 70%. Lastly, 32 cases (Group 5) had pericardial resection for conditions unrelated to primary pericardial disease. In conclusion, pericardial constriction tended to be nontubercular (100%), nongranulomatous (96%), idiopathic or iatrogenic (90%), and noncalcific (64%), and it could occur with normal pericardial thickness (4%). Because considerable overlap in the gross and microscopic features existed among cases with noncalcific pericardial constriction (Group 1), pericardial effusions (Group 3), and pericarditis (Group 4), clinical information was necessary to provide an accurate clinicopathologic interpretation.

Long-term experience with pericardiectomy: analysis of 105 consecutive patients.

A retrospective analysis of the records of 105 patients who underwent pericardiectomy from 1983 to 1993 was performed. Primarily, 40 patients (38%) had tuberculosis, 16 patients (15%) a malignancy, 12 patients (11.4%) uremia, and 11 patients (10.5%) had rheumatic disorders. Pericardiectomy was performed through midline sternotomy in all cases, 9 of them required cardiopulmonary bypass. On operation, the anterior pericardium was excised parallel to the phrenic nerves on both side. The early mortality rate was 10.5% (11 patients). Mean follow-up time was 5.8 +/- 2.1 years, ranging from 1 year to 11 years. Actuarial survival of the patients at 1 year and 5 years were 81.1% +/- 6.8% and 63.5% +/- 8.2%, respectively. We conclude that pericardiectomy using midline sternotomy with or without cardiopulmonary bypass can be performed safely and can lead to good functional results and long-term survival.

Pericardiectomy: experience from Tikur Anbessa Hospital, Addis Abeba, Ethiopia 1975-1993.

Forty-four patients had undergone pericardiectomy in Tikur Anbessa Hospital, Addis Abeba, Ethiopia from 1975 to 1993. Twenty-two of these were analysed for clinical features, etiologic diagnosis and results of treatment. Most patients were young adults with male preponderance. Clinical features coincided with findings in other series of constrictive pericarditis and intractable pericardial effusion. The operative findings at pericardiectomy was a thickened pericardium in all cases, which was adherent to the heart in the majority of cases, and with a large pericardial effusion in four cases. Histology confirmed the presence of tuberculosis in the pericardium in six cases and in the other cases it showed nonspecific chronic inflammation. Sixteen patients were discharged improved and six died after surgery.

[Pericardiectomy: a challenge, a reality. The surgical experience of the Instituto Nacional de Cardiología "Ignacio Chávez"]. / Pericardiectomía "un reto, una realidad". Experiencia quirúrgica del Instituto Nacional de Cardiología "Ignacio Chávez".

The surgical aspect of the pericardial disease has grown in the last years due to new diagnostic, surgical and anesthetic procedures. We reviewed 20 patients, who underwent pericardiectomy in the National Institute of Cardiology "Ignacio Chávez" between august 1987 and september 1992. Nine males and eleven females whose age ranged from 18 years to 57 years with a mean of 35.8 years. We found as causes of pericardial disease: 5 patients with recurrent pericardial effusion, 4 constrictive pericarditis, 2 cases with uremic pericarditis, 2 cases of "postpericardiotomy syndrome" 2 cases of infectious origin, idiopathic causes in two, others less frequent causes were neoplastic pericarditis in one, post-traumatic in one and secondary to radiotherapy in another one. The diagnosis was made by clinical findings, chest X rays, echocardiography and cardiac catheterization. A medial sternotomy was made in all patients, and the pericardium resection was made toward the anterior aspect of the phrenic nerve. In all the patients operative monitoring included central venous catheter and radial indwelling catheter, Swan Ganz catheter in 12 cases (60%) and cardiopulmonary bypass available. One death was reported in an uremic patient, secondary to low cardiac output and multiple organic failure. One year mortality increased to 10% with the inclusion of a rhabdomyosarcoma. Surgical complications included two cases (10%) with supraventricular arrhythmias, one case (5%) incomplete right bundle branch block, postoperative bleeding one (5%) and other one (5%) postoperative mediastinitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases.

OBJECTIVES: This study describes the technique, clinical characteristics and results of the first 50 patients undergoing percutaneous balloon pericardiotomy as part of a multicenter registry. BACKGROUND: Percutaneous balloon pericardiotomy involves the use of a percutaneous balloon dilating catheter to create a nonsurgical pericardial window. METHODS: Patients eligible for percutaneous balloon pericardiotomy had either cardiac tamponade (n = 36) or a moderate to large pericardial effusion (n = 14). In addition to clinical follow-up, serial echocardiograms and chest X-ray films were obtained. RESULTS: The procedure was considered successful in 46 patients after a mean follow-up period of 3.6 +/- 3.3 months. Two patients required an early operation, one for bleeding from a pericardial vessel and one for persistent pericardial catheter drainage. Two patients required a late operation for recurrent tamponade. Minor complications of the procedure included fever in 6 of the first 37 patients (studied before the prophylactic use of antibiotic agents), thoracentesis or chest tube placement in 8 and a small spontaneously resolving pneumothorax in 2. Despite the short-term success of this procedure, the long-term prognosis of the 44 patients with malignant pericardial disease remained poor (mean survival time 3.3 +/- 3.1 months). CONCLUSIONS: Percutaneous balloon pericardiotomy is successful in helping to manage large pericardial effusions, particularly in patients with a malignant condition. It may become the preferred treatment to avoid a more invasive procedure for patients with pericardial effusion and a limited life expectancy.

Pericardial drainage: subxiphoid vs. transthoracic approach.

The optimal management of effusive pericardial disease remains controversial. Subxiphoid drainage has been criticized for a high recurrence rate while transthoracic procedures (window or pericardiectomy) are more invasive operations with greater potential for morbidity. We compared subxiphoid (SX group) and transthoracic (TT group) drainage in 131 patients (age range from 1 month to 81 years) treated from 1979 to the present. The etiology of effusion included cancer (38), uremia (24), infection (27), radiation (9), and other (33) causes. The two groups had similar age and sex distribution, etiology, and fluid volume. There was no difference in the operative mortality between the two groups (SX 15%, TT 13%, p = NS). Patients undergoing thoracotomy for treatment of effusive pericardial disease had a higher incidence of respiratory complications as defined by the presence of pneumonia, pleural effusion, prolonged ventilation, and need for reintubation (SX 11%, TT 35%, p less than 0.005). This may account, in part, for the longer mean hospital stay in transthoracic group (14.4 vs. 11.4 days). Nine patients were lost to follow-up after hospital discharge. The remaining 104 hospital survivors were followed for between 1 month and 11 years (mean 34 months, cumulative of 297 patient years). Three patients in each group experienced fluid recurrence and all but one were successfully treated by needle aspiration or percutaneous catheter placement. Following discharge, no patient required reoperation for effusive or constrictive pericardial disease or died from tamponade. There were no significant differences in 5-year actuarial survival (SX 54%, TT 49%) or actuarial freedom from recurrence (SX 89%, TT 93%).(ABSTRACT TRUNCATED AT 250 WORDS)