Sternal Bur Hole Pericardiotomy for Cardiac Tamponade Caused by Primary Lung Cancer

Abstract

Thirty-six cases of sternal bur hole pericardiotomy for cardiac tamponade caused by carcinomatous pericarditis associated with primary lung cancer were studied. Most patients had advanced disease, such as carcinomatous lymphangiosis, carcinomatous pleuritis, distant metastasis, and superior vena cava syndrome. Seventeen cases received treatment by only removal of pericardial effusion and the remaining 19 cases had local instillation of antineoplastic agents after drainage. In 30 cases the drainage tube was removed and the drainage period ranged from 3 to 30 days (mean 13.4). Seven cases had systemic chemotherapy or radiotherapy after drainage. In 27 out of 30 cases, there were no reaccumulation of pericardial effusion and no recurrence of cardiac tamponade more than 30 days and 13 cases could leave hospital. There was only one case of bleeding during operation. Median survival time was 78 days (3 to 904 days) and the cause of death was cancer and respiratory failure caused by carcinomatous lymphangiosis and carcinomatous pleuritis in almost all cases. We suggest that sternal bur hole pericardiotomy is one of the most effective and safe therapeutic method for cardiac tamponade caused by carcinomatous pericarditis.