J Cardiovasc Surg
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A subxiphoid pericardial window made in 123 patients allowed drainage and diagnosis of pericardial effusions. In 40 patients with malignancy and effusions, median drainage was 450 ml; cytology was positive in 17 or 36 (47%), and pericardial biopsy showed cancer in 13 (43%) of 30 patients. In 11 patients with malignancy, both cytology of effusions and biopsy of the pericardium were negative. ⋯ No deaths resulted from recurrent effusions. The establishment of a subxiphoid pericardial window allows rapid and safe drainage of pericardial effusions with sampling for cytology and pericardial biopsy. It has minimal morbidity and few recurrent effusions.
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Venous return for cardiopulmonary bypass is successfully achieved using of two stage cavoatrial cannula. Right heart decompression is facilitated and drainage optimized by the use of a caval occluding clamp which stabilizes the cannula. This technique is described.