Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?

PURPOSE: To assess whether drainage of pericardial effusion by pericardiocentesis or surgery is justified as a routine measure in the initial management of patients with large pericardial effusion without tamponade or suspected purulent pericarditis. SUBJECTS AND METHODS: All patients with large pericardial effusion without tamponade or suspected purulent pericarditis who were seen at our institution during a span of 6 years (1990 to 1995) were retrospectively (46) or prospectively (25) reviewed. Large pericardial effusion was defined as a sum of echo-free pericardial spaces in diastole exceeding 20 mm.
RESULTS: Large pericardial effusion was diagnosed in 162 patients, 71 of whom fulfilled criteria for inclusion. Of these, 26 underwent a pericardial drainage procedure. Diagnostic yield was 7%, as only 2 specific diagnoses were made using these procedures. During follow-up (95% of patients, median 10 months), no patient developed cardiac tamponade or died as a result of pericardial disease, nor did any new diagnoses become manifest in the 45 patients who did not have pericardial drainage initially. Moderate or large effusions persisted in only 2 of 45 patients managed conservatively.
CONCLUSIONS: Routine pericardial drainage procedures have a very low diagnostic yield in patients with large pericardial effusion without tamponade or suspected purulent pericarditis, and no clear therapeutic benefit is obtained with this approach. Clinical outcomes depend on underlying diseases, and do not appear to be influenced by drainage of pericardial fluid.