Search

The purpose of this study was to evaluate in a dog model whether intrapericardial instillation of tetracycline is superior to the effect of drainage alone in causing pericardial adhesions and cavity obliteration. Twelve mongrel dogs were randomly divided into two experimental groups. All dogs received a pericardial drain through a sterile thoracotomy. Group A dogs (n = 6) received minocycline hydrochloride, 20 mg/kg, group B received normal saline. All dogs were sacrificed 1 month later. Echocardiograms performed 1 week postsurgery were normal in all dogs. Macroscopic evaluation disclosed that all group A dogs had over 25% cavity obliteration whereas group B dogs had no adhesions or had obliteration of less than 25% of the cavity area. Microscopic evaluation showed that group A dogs had severe pericardial fibrosis and thickening with slight focal lymphoplasmocytic infiltration. Myocardial damage was not seen. Our results support the clinical use of injecting tetracycline into the pericardium (in addition to drainage) to cause cavity obliteration in patients with persistent pericardial effusion.

Purpose : To compare the outcome of patients with radiation-induced constrictive pericarditis versus patients with constriction due to another etiology. Methods and materials : Twenty patients with constrictive pericarditis seen during 1975–1986 at a single medical center. Six had radiation-induced constrictive pericarditis (Group A). The etiology was idiopathic in ten subjects and secondary to carcinomatous encasement, chronic renal failure, purulent infection and tuberculosis in one patient each (Group B, N = 14). Mean age was 53.4 ± 15.5 years. Results : Extensive pericardiectomy was performed in 3 6 Group A and 13 14 Group B patients. All Group A patients died, 4 weeks—11 years post-diagnosis (median = 10 months). Two Group A patients died suddenly, one died post-operatively of respiratory failure, another of pneumonia and two of recurrent carcinoma. Thirteen Group B patients are alive (median follow-up = 72 months). The only death in this group was due to metastatic cancer. Conclusion : The poor outcome with radiation-induced constriction is probably multi-factorial. Poor surgical outcome is to be expected in patients with evidence of recurrent tumor, high-dose irradiation, pulmonary fibrosis or associated radiation-induced myocardial, valvular or coronary damage.