Pericardiectomy for Treatment of Uremic Pericarditis

Pericardial effusion and tamponade are complications of chronic renal failure for which treatment is not fully satisfactory. Pericardiocentesis, corticosteroids, intensified hemodialysis, and pericardiectomy are therapeutic measures utilized. In a 44-month period 30 uremic patients with pericardial effusion were evaluated, representing approximately 12% of our total dialysis population. All had clinical evidence of pericarditis and effusion documented by studies utilizing various techniques (radioisotope scan, carbon dioxide study, X-ray contrast study). Nineteen of the 30 patients underwent partial pericardiectomy. Surgical treatment was undertaken because of (1) evidence of tamponade, (2) recurrent hypotension during dialysis, or (3) persistence of a lax effusion not responding to repeated hemodialysis. Sixteen of the 19 patients are alive and stable at an average of 14 months after the surgical procedure. Death in three patients was unrelated to surgery or pericardial disease. No significant early or late complications have been observed.

Partial pericardiectomy is a safe and effective method for treating clinically significant uremic pericardial effusions. Pericardiectomy can prevent or relieve tamponade, alleviates hypotensive complications of dialysis in selected patients, and appears to cure what is sometimes a chronic or recurring problem in patients undergoing chronic hemodialysis.