Large malignant pericardial effusions are managed by draining the fluid, unless the goals of therapy are to use a less invasive approach that may improve quality of life but not help the patient live longer. The goals of therapy depend on a number of factors, including the following:
Treatment options include the following:
In some patients, fluid may again collect in the pericardium after pericardiocentesis. A catheter may be inserted and left in place to allow continued drainage. This procedure may be used for patients with advanced cancer instead of more invasive surgery.
A procedure to close the pericardium so fluid cannot collect in the cavity. Fluid is first removed by pericardiocentesis. A drug or chemical that causes the pericardium to close is then injected through a catheter into the pericardial space. Three or more treatments may be needed to completely close the pericardium.
A surgical incision is made in the chest and then in the pericardium to insert a drainage tube. This increases the quantity of fluid that can be drained from the pericardium.
Surgery to remove part of the pericardium. This may be done when there are chronic infections of the pericardium or to drain fluid quickly when cardiac tamponade occurs. This surgery is also called pericardial window.
A catheter with a balloon tip is inserted through the chest and into the pericardium. The balloon is then inflated to enlarge the pericardial opening and allow fluid to drain into the pleural cavity. This may be used when an effusion has recurred (come back) after pericardiocentesis or as an alternative to more invasive surgery.