Malignant
pericardial effusion can result in acute
cardiac tamponade with serious hemodynamic compromise. This condition requires prompt pericardial
decompression for relief of symptoms; however, the risks of
general anesthesia in this setting are considerable. In a series of 12 patients, all operated on under
local anesthesia without operative mortality, there were six patients with malignant
pericardial effusion secondary to lung
carcinoma; four patients, secondary to
breast carcinoma; one patient, secondary to
squamous cell carcinoma of the oral cavity; and one patient, secondary to an unknown primary. The clinical presentation of each was abrupt and echocardiography was definitive. The procedure is performed through an upper abdominal midline incision. The xiphoid process is excised, the diaphragm is visualized, and a pericardial window is created through which two
chest tubes are placed through separate stab incisions. The tubes are removed when the drainage has subsided, usually 3-7 days. No medication or
irritant is instilled. There was no recurrence following this treatment. The average survival time was 27 weeks with a range of 2-153 weeks. This operation should be part of the repertoire of the general surgeon who treats
breast cancer and of the thoracic surgeon who treats
lung cancer.