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(Chest. 1995;107:1522-1525.)
© 1995 American College of Chest Physicians

The Role of the `Pericardial Window' in AIDS

David R. Flum MD1; Joseph T. McGinn Jr. MD1; and Denis H. Tyras MD1

1 From the Department of Surgery, Division of Cardiothoracic Surgery, St. Vincent's Hospital and Medical Center, New York

Background: The leading cause of pericardial effusion in urban hospitals is now AIDS-related pathologies. Clinically, these effusions are a diagnostic and management dilemma. In our institution, pericardial biopsy and operative drainage have become part of the diagnostic and management plan. Surgical intervention, however, has appeared to have little clinical impact.

Methods: A retrospective review was conducted of all patients (n=29) diagnosed as having AIDS who underwent "pericardial window" for pericardial effusions from 1986 to 1994.

Results: Fluid cultures and pericardial biopsy were performed in all cases. Twenty-four percent of culture or biopsy specimens were diagnostic (7 of 29=2 adenocarcinoma, 3 lymphoma, 1 Staphylococcus aureus, 1 Mycobacterium tuberculosis). In 94% of cases, there was no change in clinical management based on operative results. In 4 of 7 cases, the patients were ineligible for the indicated therapy based on underlying illness and in 1 of 7, the patient was receiving appropriate therapy for previously diagnosed disease. Ventilatory complications were noted in 17%. Three patients did not wean from the ventilator and died shortly after the operation. Sixty-nine percent mortality was noted at 8 weeks postoperatively. One hundred percent mortality was noted at 22 weeks with 86% follow-up.

Conclusion: AIDS-related pericardial effusion is associated with a grave prognosis. Operations for diagnostic benefit provide little practical information and are not justified.

Key Words: AIDS • pericardial effusion • pericardial window

Submitted on August 29, 1994
Accepted on October 13, 2007




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