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Large pericardial effusions of inflammatory origin in childhood

Published online by Cambridge University Press:  18 April 2005

Geoffrey Chi Fung Mok
Affiliation:
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
Samuel Menahem
Affiliation:
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia

Abstract

Objectives: Our aim was to review the clinical records from children with large pericardial effusions of inflammatory origin presenting to a tertiary referral centre over the last 21 years, with emphasis on their clinical presentation, management and outcome. Background: The common identifiable causes of pericardial effusion in children include prior cardiac surgery, bacterial pericarditis, malignancy, and connective tissue disorders. In a significant number of children, however, despite extensive investigation, it is not possible to identify a clear aetiology. A viral cause is often considered, though rarely confirmed. The clinical course of such large idiopathic pericardial effusions in children has not been extensively reported. Methods and results: We reviewed retrospectively the records of all patients seen between 1981 and 2001 with large pericardial effusions of inflammatory origin requiring drainage, excluding the effusions related to cardiac surgery or malignancy. We found 31 patients fulfilling our criterions for study. They could be divided into three groups, with 15 patients having no specific identifiable aetiology despite extensive investigation, 12 patients having evidence of bacterial pericarditis, and four with a probable immunologic disorder. Fever was present in only eight patients (53%) in the idiopathic group. All patients in the other groups had fever. Except for fever and the resultant tachycardia, it was not possible to distinguish on clinical grounds, nor on the presence or otherwise of cardiac tamponade, between those with idiopathic aetiology and those with bacterial infection. Of the patients with presumed bacterial pericarditis, five (42%) had both positive blood and pericardial fluid cultures, three (25%) had positive blood cultures, while a further three patients (25%) had only positive pericardial fluid cultures. All patients required drainage of the pericardial effusion, either under echocardiographic guidance or surgically. None of the patients died. The hospital stay was significantly shorter for those with idiopathic as opposed to bacterial pericarditis. Of those with an idiopathic aetiology, six required readmission due to recurrence of the pericardial effusion, with four patients requiring further surgical drainage. No patients required readmission with a bacterial or immunologic aetiology. No patient developed constrictive pericarditis after a median follow-up of 22 months. Conclusion: Patients with large idiopathic pericardial effusion had relatively few constitutional symptoms as compared with their gross echocardiographic findings. Those with bacterial pericarditis had more urgent need for treatment. Patients with pericardial effusion of inflammatory origin, when treated appropriately, had an excellent outcome with no mortality or development of constrictive pericarditis.

Type
Original Article
Copyright
© 2003 Cambridge University Press

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References

Rheuban KS. Pericardial diseases. In: Allen HD, Gutgesell HP, (eds). Moss and Adams' heart disease in infants, children, and adolescents: including the fetus and young adult. 6th ed. Lippincott Williams & Wilkins, 2001, pp 12871296.
Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109: 95101.Google Scholar
Soler-Soler J, Sagristà-Sauleda J, Permanyer-Miralda G. Management of pericardial effusion. Heart 2001; 86: 235240.Google Scholar
Callahan JA, Seward JB, Nishimura RA, et al. Two-dimensional echocardiographically guided pericardiocentesis: experience in 117 consecutive patients. Am J Cardiol 1985; 55: 476479.Google Scholar
Gibbs CR, Watson RD, Singh SP, Lip GY. Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population. Postgrad Med J 2000; 76: 809813.Google Scholar
Roodpeyma S, Sadeghian N. Acute pericarditis in childhood: a 10-year experience. Pediatr Cardiol 2000; 21: 363367.Google Scholar
Sagristà-Sauleda J, Barrabés JA, Permanyer-Miralda G, Soler-Soler J. Purulent pericarditis: review of a 20-year experience in a general hospital. J Am Coll Cardiol 1993; 22: 16611665.Google Scholar
Dupuis C, Gronnier P, Kachaner J, et al. Bacterial pericarditis in infancy and childhood. Am J Cardiol 1994; 74: 807809.Google Scholar
Medary I, Steinherz LJ, Aronson DC, La Quaglia MP. Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage. J Pediatr Surg 1996; 31: 197200.Google Scholar
Tsang TS, Barnes ME, Hayes SN, et al. Clinical and echocardiographic characteristics of significant pericardial effusion following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management. Chest 1999; 116: 322331.Google Scholar
Bland M. An introduction to medical statistics. 2nd ed. Oxford Medical Publications, 1995.
Sagristà-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med 1999; 341: 20542059.Google Scholar
Moores DW, Allen KB, Faber LP, et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cradiovasc Surg 1995; 109: 546552.Google Scholar
Zahn EM, Houde C, Benson L, Freedom RM. Percutaneous pericardial catheter drainage in childhood. Am J Cardiol 1992; 70: 678680.Google Scholar
Blake S, Bonar S, O'Neill H, et al. Aetiology of chronic constrictive pericarditis. Br Heart J 1983; 50: 273276.Google Scholar
Hugo-Hamman CT, Scher H, DeMoor MM. Tuberculous pericarditis in children: a review of 44 cases. Pediatr Infect Dis J 1994; 13: 1318.Google Scholar
Cheatham JE, Grantham RN, Peyton MD, et al. Hemophilus influenzae purulent pericarditis in children. J Thorac Cardiovasc Surg 1980; 79: 933936.Google Scholar
Ferreira SMAG, Ferreira Jr. AB, Morais AdoN, Paz WS, Silveira FAA. Constrictive chronic pericarditis in children. Cardiol Young 2001; 11: 210213.Google Scholar