Author(s)

Tsirimalala Rajaobelison¹, Zakarimanana Lucas Randimbinirina^1*, Maharo Ramifehiarivo¹, Manoahasina Ranaliarinosy Rabarison², Toky Mamin’ny Aina Rajaonanahary³, Andriamihaja Jean-Claude Rakotoarisoa⁴

¹Department of Cardiovascular Surgery, Faculty of Medicine of Antananarivo, University of Antananarivo, Antananarivo, Madagascar.
²Department of Pathology, Faculty of Medicine of Antananarivo, University of Antananarivo, Antananarivo, Madagascar.
³Department of Vascular Surgery, Faculty of Medicine of Antananarivo, University of Antananarivo, Antananarivo, Madagascar.
⁴Department of Thoracic Surgery, Faculty of Medicine of Antananarivo, University of Antananarivo, Antananarivo, Madagascar.

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.

Tuberculosis, Echocardiography, Pericardial Effusion, Surgery, Cardiac Tamponade

Rajaobelison, T. , Randimbinirina, Z. , Ramifehiarivo, M. , Rabarison, M. , Rajaonanahary, T. and Rakotoarisoa, A. (2024) Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo. World Journal of Cardiovascular Surgery, 14, 21-31. doi: 10.4236/wjcs.2024.142003.