Intrapericardial treatment of neoplastic pericardial effusions

Alessandro Martinoni, Carlo Maria Cipolla, Maurizio Civelli, Daniela Cardinale, Guiseppina Lamantia, Marco Colleoni, Filippo DeBraud, Giuseppe Susini, Giovanni Martinelli, Aaron Goldhirsh, Cesare Fiorentini

Research output: Contribution to journalArticlepeer-review

Abstract

Pericardial effusion and cardiac tamponade are known complications of many advanced malignancies as lung cancer, breast cancer, lymphomas and leukemias. Initial relief can be easily obtained with percutaneous echo-guided pericardiocentesis, without significant mortality and morbidity and well-tolerated even in critically ill patients. Effusion recurrences can be observed, however, in up to 40% of cases if only simple pericardial drainage is performed. Effective management can be obtained by instillation in the pericardial sac of different agents, with sclerosing or cytostatic activity, like tetracyclines, bleomycin, thiotepa or radionuclides. Intrapericardial sclerotherapy is associated to good results in terms of recurrence prevention and survival improvement. Absence of pericardial effusion at 30 days after drainage can be observed in 70 to 90% of all treated patients, without significant variations among different treatments. No significant side effects are observed, with the exclusion of chest pain during tetracyclines instillation. In our opinion pericardiocentesis associated to intrapericardial sclerotherapy with thiotepa is the best compromise in terms of recurrence prevention, tolerability and costs. Real randomized, case-control studies are moreover required to assess the gold standard of malignant pericardial effusions treatment.

Original languageEnglish
Pages (from-to)787-793
Number of pages7
JournalHerz
Volume25
Issue number8
Publication statusPublished - 2000

Keywords

  • Cisplatin
  • Intrapericardial treatment
  • Neoplasia
  • Pericardial effusion
  • Sclerotherapy
  • Thiotepa

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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