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Pericardiectomy in uremia. The treatment of choice for cardiac tamponade in chronic renal failure.

Pericardial effusion with cardiac tamponade in chronic renal failure is treated conventionally by aggressive dialysis, repeated pericardicentesis, and less often, by surgery (pericardial window or partial pericardiectomy). Although serious complications have followed pericardial aspiration in several reported cases, it continues to be the most widely practiced therapeutic maneuver. Pericardicentesis was performed in four patients on our longterm dialysis program during a one-year period. Serious complications occurred in all, and proved fatal in three. Surgical intervention in one of the three who died, and in two other patients, resulted in immediate relief of cardiac embarrassment without surgical complications or subsequent recurrence of tamponade. We recommend elective partial pericardiectomy in all patients with uremic cardiac tamponade. Pericardicentesis should be reserved for dire emergencies only. (JAMA228:1132-1135, 1974)