HIV induced pericarditis surgery: Difference between revisions

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{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


==Treatment==
==Surgery==
*Asymptomatic with mild to moderate [[pericardial effusion]]:
:*Mostly idiopathic and resolves spontaneously.
:*However, asymptomatic effusions in [[HIV]] occur in advanced stages of the disease or they signal the onset of full-blown [[AIDS]]. These asymptomatic effusions require treatment to improve survival.<ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref> [[HAART]] therapy has significantly reduced the incidence and severity of cardiac complications associated with [[HIV]].<ref name="pmid16330702">Ntsekhe M, Hakim J (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16330702 Impact of human immunodeficiency virus infection on cardiovascular disease in Africa.] ''Circulation'' 112 (23):3602-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.549220 DOI:10.1161/CIRCULATIONAHA.105.549220] PMID: [http://pubmed.gov/16330702 16330702]</ref><ref name="pmid16781213">Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16781213 Cardiovascular disease in HIV infection.] ''Am Heart J'' 151 (6):1147-55. [http://dx.doi.org/10.1016/j.ahj.2005.07.030 DOI:10.1016/j.ahj.2005.07.030] PMID: [http://pubmed.gov/16781213 16781213]</ref>


*Symptomatic large effusions without [[cardiac tamponade]]:
*Symptomatic large effusions without [[cardiac tamponade]]:
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*Large [[pericardial effusion]]s with unknown etiology:
*Large [[pericardial effusion]]s with unknown etiology:
:*[[Tuberculous pericarditis#Anti-tuberculosis chemotherapy|Empiric antituberculous therapy]] for M.tuberculosis have shown some benefit in patients with AIDS.<ref name="pmid1898769">Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1898769 Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.] ''N Engl J Med'' 324 (5):289-94. [http://dx.doi.org/10.1056/NEJM199101313240503 DOI:10.1056/NEJM199101313240503] PMID: [http://pubmed.gov/1898769 1898769]</ref><ref name="pmid3723722">Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3723722 Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS).] ''JAMA'' 256 (3):362-6. PMID: [http://pubmed.gov/3723722 3723722]</ref><ref name="pmid17976506">Syed FF, Mayosi BM (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17976506 A modern approach to tuberculous pericarditis.] ''Prog Cardiovasc Dis'' 50 (3):218-36. [http://dx.doi.org/10.1016/j.pcad.2007.03.002 DOI:10.1016/j.pcad.2007.03.002] PMID: [http://pubmed.gov/17976506 17976506]</ref>
:*[[Tuberculous pericarditis#Anti-tuberculosis chemotherapy|Empiric antituberculous therapy]] for M.tuberculosis have shown some benefit in patients with AIDS.<ref name="pmid1898769">Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1898769 Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.] ''N Engl J Med'' 324 (5):289-94. [http://dx.doi.org/10.1056/NEJM199101313240503 DOI:10.1056/NEJM199101313240503] PMID: [http://pubmed.gov/1898769 1898769]</ref><ref name="pmid3723722">Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3723722 Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS).] ''JAMA'' 256 (3):362-6. PMID: [http://pubmed.gov/3723722 3723722]</ref><ref name="pmid17976506">Syed FF, Mayosi BM (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17976506 A modern approach to tuberculous pericarditis.] ''Prog Cardiovasc Dis'' 50 (3):218-36. [http://dx.doi.org/10.1016/j.pcad.2007.03.002 DOI:10.1016/j.pcad.2007.03.002] PMID: [http://pubmed.gov/17976506 17976506]</ref>
*Other causes of pericarditis, including bacterial and fungal infections, should be identified and treated accordingly.
*Pericarditis due to [[lymphoma]]:
:*[[Radiation]] and [[chemotherapy]] have been tried.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref><ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient.] ''Leuk Lymphoma'' 48 (1):209-11. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> However, the response has been transient,<ref name="pmid9760158">Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9760158 Cardiac involvement in HIV-related non-Hodgkin's lymphoma: a case report and short review of the literature.] ''Ann Hematol'' 77 (1-2):75-8. PMID: [http://pubmed.gov/9760158 9760158]</ref> and the associated chemotherapy has significantly increased the risk of death secondary to [[opportunistic infection]]s.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref>
====Supportive Trial Data====
*The incidence of [[pericardial effusion]] in patients with asymptomatic [[AIDS]] was 11% per year before the introduction of effective [[highly active antiretroviral therapy]] (HAART). The 6 month survival rate of [[AIDS]] patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of [[CD4]] count and [[albumin]] levels.<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>


==References==
==References==
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[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date cardiology]]
[[Category:Needs overview]]


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Revision as of 20:24, 11 December 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Surgery

  • Requires pericardiocentesis for both therapeutic and diagnostic purposes, to identify possible etiology.
  • Occurs in 33-40% of patients.[1]
  • Warrants immediate pericardiocentesis and a catheter is placed in the pericardial sac for the next 48 hours to continuously drain fluid by underwater-seal suction.

References

  1. ↑ Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 137 (3):516-21. PMID: 10047635
  2. ↑ Flum DR, McGinn JT, Tyras DH (1995) The role of the 'pericardial window' in AIDS. Chest 107 (6):1522-5. PMID: 7781340
  3. ↑ Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) Pericardial effusion and AIDS: benefits of surgical drainage. Eur J Cardiothorac Surg 13 (2):165-9. PMID: 9583822
  4. ↑ Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC et al. (1993) Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases. J Am Coll Cardiol 21 (1):1-5. PMID: 8417048
  5. ↑ Marcy PY, Bondiau PY, Brunner P (2005) Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol 15 (9):2000-9. DOI:10.1007/s00330-004-2611-y PMID: 15662494
  6. ↑ Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med 324 (5):289-94. DOI:10.1056/NEJM199101313240503 PMID: 1898769
  7. ↑ Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA 256 (3):362-6. PMID: 3723722
  8. ↑ Syed FF, Mayosi BM (2007) A modern approach to tuberculous pericarditis. Prog Cardiovasc Dis 50 (3):218-36. DOI:10.1016/j.pcad.2007.03.002 PMID: 17976506

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