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August 27, 1982

Subxiphoid Pericardiotomy-Reply

Author Affiliations

Lenox Hill Hospital New York

JAMA. 1982;248(8):923. doi:10.1001/jama.1982.03330080013012

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In Reply.—  The experience of Breyer and associates supports our impression that subxiphoid pericardiotomy is a procedure of choice for the treatment of acute cardiac tamponade. It is of particular note that these authors report one patient with a small right ventricular laceration from an attempted, but unsuccessful, pericardiocentesis. No complications from subxiphoid pericardiotomy occurred.The shorter drainage time reported by Breyer et al underscores the need to individualize removal of the catheter based on the quantity of daily drainage. We routinely remove the catheter when less than 30 mL of fluid has been drained during a 24-hour period. It is apparent from the data provided by Breyer et al that our population, which contained more uremic patients, experienced a much greater quantity of drainage fluid of from 300 to 3,400 mL (average, 1,133 ±192 mL). The longer drainage periods were not unexpectedly associated with the cases of highest fluid