With regard to the therapy of a pericardial effusion, it is of course necessary to distinguish between the therapy of the effusion itself and the therapy of the potentially underlying disease.
The therapeutic measures for the treatment of the three potentially possible tumors for a pericardial effusion are unfortunately very limited. With regard to hemangioma sarcoma, chemotherapy can be tried but is not recommended due to its unsatisfactory benefit. In the best case, the disease process can be delayed by a few months, but healing is impossible.
For the treatment of cardiac tumors, chemotherapy is not even a question, since these types of tumors do not respond to chemotherapeutic agents. The operative removal of such a tumor is also not recommended at the present time.
For the treatment of pathological accumulations of fluid in the heart bag, the pericardial effusion itself, only a pericardial paracentesis (that means a puncturing of the heart bag) is a possible solution. In this procedure, which should only be carried out by an experienced cardiologist, the heart bag is punctured through the chest wall with the aid of a catheter and the pathological fluid suctioned off. As unfortunately, there aren’t any medicines that counteract the recurrence of pericardial effusions, the pericardial paracentesis must always be carried out in case of doubt. However, with every operation there is always the risk to injure, e.g. the heart, the lungs or vessels with the catheter. Additionally the constant inflammatory irritation in the heart bag itself can lead to a constrictive pericarditis (= thickening/calcification of the heart bag) and therefore the pericardial paracentesis should not be performed permanently.
For dogs which are prone to chronic recurrent pericardial effusions, either a pericardectomy or pericardial fenestration is recommended. Both methods are surgical procedures: during pericardectomy almost the entire heart bag itself is removed. In a pericardial fenestration, several holes are cut into the heart-bag, which ensure an efflux of the accumulating fluid into the thoracic cavity, where it is then removed from the lymph vessels.
Whether and how often a pericardial effusion arises again cannot be predicted in any way. In some cases of idiopathic effusions, a single puncture is sufficient, in other cases the accumulation of water regularly occurs so that surgical intervention is unavoidable. In general, malignant causes are more frequent and quicker to repeated effusion than with benign causes; in hemangioma sarcomas, new water accumulations can occur within a few hours.
Also with regard to the prognosis, of cause the underlying cause of the pericardial effusion is very important.
Dogs with a hemangioma sarcoma have an average life of 3-6 months. For cardiac tumors, the prognosis is slightly better due to the slow-moving growth and therefore a life expectancy of up to 1-2 years must be expected. Also for mesotheliomas, the prognosis is unfortunately also very unfavorable.
Idiopathic pericardial effusions, on the other hand, have a very good prognosis – especially when combined with surgery.