Effusive Pericarditis (Incessant)

My husband has effusive pericarditis. He has had 2 pericardiocentesis procedures in the last 2 months, and the effusion is returning again. The diagnosis seems to be idiopathic pericarditis as all of the very extensive tests for a cause have been negative. He has been on colchicine since the initial diagnosis and has tried both NSAIDs and prednisone. The latter seems to slow the rate of effusion but not eliminate it altogether. There was initial inflammation as his SED rate was 87 after the first procedure; a more recent test gave a value of 1 but he was on steroids at the time.

Since the effusion is not ceasing by these treatments, they are recommending a pericardectomy (the surgeon). The cardiologists had been mentioning a pericardial window as the next step, but the surgeon says that that (1) always closes anyway and (2) does nothing to treat the underlying inflammation (at least he says that second hand; we have not been able to speak to him yet). Is this the current thinking that the window is not worth doing in such cases? Pericardectomy seems like such a drastic step that we'd like to be sure that everything less invasive was really not worth trying. Also, Bernhard Maisch has a procedure that involves introducing liquid steroids into the pericardium to treat chronic (mostly non-effusive) pericarditis. Does this procedure hold any hope for cases of chronic effusive pericardisits like my husband's?

Thanks in advance.

[Cleveland Clinic]

Pericardioectomy is a very extensive surgery, that almost never removes the entire pericardium. Because of its inherent risks, we almost always precede one of these procedures with a pericardial window, and if it works then the more extensive surgery is avoided.
I don't know much evidence behind the intra-pericardial steriod injection. Certainly at best this is an experimental procedure, and this means this is unproven therapy, which has the possibility of damaging the heart. If oral steroids and a pericardial window control his symptoms, than this is the way to proceed first. Make sure there has been an extensive search for exudative causes of pericarditis, because this could be a life threatening condition such as a myocardial infarction, cancer or pulmonary embolus.

[aeleen]

Something else I should have included: my husband's effusions were both very large: 1.5L and 1.0L, respectively.