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August 27, 1982

Subxiphoid Pericardiotomy

Author Affiliations

Bowman Gray School of Medicine of Wake Forest University Winston-Salem, NC

JAMA. 1982;248(8):923. doi:10.1001/jama.1982.03330080013011

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To the Editor.—  Alcan et al describe the use of subxiphoid pericardiotomy for the treatment of pericardial effusion (1982;247:1143) and conclude that subxiphoid pericardiotomy is the procedure of choice for acute cardiac tamponade. Our own experience in 12 cases of acute cardiac tamponade strongly supports those conclusions.We have performed subxiphoid pericardiotomy (using only local anesthesia) in 12 patients during the past 18 months. The amount of fluid drained ranged from 50 to 2,000 mL (average, 650 mL). The drainage tube was removed after two to seven days (average, 4.3 days). No drugs were instilled through the tube.The cause of the pericardial effusion was obvious in ten patients: seven had carcinoma metastatic to the pericardium; three had uremic pericarditis. Pericardial biopsy supported the diagnosis of nonspecific pericarditis in one of the other two patients; in the 12th patient, who had known breast cancer and bony metastases, metastatic pericarditis was