TITLE:
Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo
AUTHORS:
Tsirimalala Rajaobelison, Zakarimanana Lucas Randimbinirina, Maharo Ramifehiarivo, Manoahasina Ranaliarinosy Rabarison, Toky Mamin’ny Aina Rajaonanahary, Andriamihaja Jean-Claude Rakotoarisoa
KEYWORDS:
Tuberculosis, Echocardiography, Pericardial Effusion, Surgery, Cardiac Tamponade
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.14 No.2,
February
29,
2024
ABSTRACT: Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African
countries. The aim of this study was to describe the diagnosis and the surgical
management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular Surgery Unit
for 10 years-period (from January 2012 to December 2021), including all cases of
drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven
cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average
age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen
patients (13.43%) had a previous history of pulmonary tuberculosis. The most common
risk factors for tuberculosis infection were malnourishment (80.59%), indoor air
pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest
symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia
(95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs
of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage
(39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%).
Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion.
All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial
effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the
diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients
with massive pericardial effusion. Histopathology of pericardial biopsies made a
definitive diagnosis for tuberculosis.