Management of Pericardial Effusion in Terminal Cancer Patients

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Management of Pericardial Effusion in Terminal Cancer Patients 家庭醫學部 林曉凌 醫師 2020/10/6 台大醫院 回到第一頁

Management of Pericardial Effusion in Terminal Cancer Patients 家庭醫學部 林曉凌 醫師 2020/10/6 台大醫院 回到第一頁

Symptoms n n n Dyspnea Chest pain Orthopnea Cough Fatigue and Malaise 2020/10/6 台大醫院

Symptoms n n n Dyspnea Chest pain Orthopnea Cough Fatigue and Malaise 2020/10/6 台大醫院 回到第一頁

Signs n n n Paradoxical pulse (>12 mm. Hg) Jugular venous distention Jugular venous

Signs n n n Paradoxical pulse (>12 mm. Hg) Jugular venous distention Jugular venous pressure >10 mm. Hg Tacchycardia Hypotension 2020/10/6 台大醫院 回到第一頁

Initial Therapy n n Pericardiocentesis Percutaneous continuous drainage Successful in alleviating symptoms (97. 1%)

Initial Therapy n n Pericardiocentesis Percutaneous continuous drainage Successful in alleviating symptoms (97. 1%) High recurrence rate (25% - 62%) 2020/10/6 台大醫院 回到第一頁

Preventive Modalities n n Intrapericardial sclerotherapy Tetracycline Doxycycline Bleomycin Cisplatin Percutaneous Balloon Pericardial Window

Preventive Modalities n n Intrapericardial sclerotherapy Tetracycline Doxycycline Bleomycin Cisplatin Percutaneous Balloon Pericardial Window (PBPW) 2020/10/6 台大醫院 回到第一頁

Surgical Intervention n Subxyphoid pericardial window procedure Thoracotomy with partial pericardiotomy VATS created pericardial

Surgical Intervention n Subxyphoid pericardial window procedure Thoracotomy with partial pericardiotomy VATS created pericardial window 2020/10/6 台大醫院 回到第一頁

Methods of PBPW n n Conventional subxyphoid pericardiocentesis Guide wire advanced into the pericardium

Methods of PBPW n n Conventional subxyphoid pericardiocentesis Guide wire advanced into the pericardium A balloon dilating catheter straddled across the pericardium Balloon inflated to create a window 2020/10/6 台大醫院 回到第一頁

Results of PBPW n n Successful rate 96. 4% Complications 1. Pleural effusions requiring

Results of PBPW n n Successful rate 96. 4% Complications 1. Pleural effusions requiring thoracentesis 14. 3% 2. Transient fever 10. 7% 3. Small pneumothorax 3. 6% 2020/10/6 台大醫院 回到第一頁

REFERENCES n n Galli M, Politi A, et al. Percutaneous Balloon Pericardiotomy for Malignant

REFERENCES n n Galli M, Politi A, et al. Percutaneous Balloon Pericardiotomy for Malignant Pericardial Tamponade. Chest. 1995; 108: 1499 -1501. Vaitkus PT, Hermann HC, Le. Winter MM. Treatment of Malignant Pericardial Effusion. JAMA. 1994; 272: 59 -64. Laham RJ, Cohen DJ, et al. Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart. 1996; 75: 67 -71. Leonard NG, Robert JG, Michael EB. Pericardiocentesis and Intrapericardial Sclerosis: Effective Therapy for Malignant Pericardial Effusions. Ann Thorac Surg. 1997; 64: 1422 -8. 2020/10/6 台大醫院 回到第一頁