Introduction: Massive pericardial effusion is a potentially dangerous condition. The aims of management are symptomatic relief and getting an accurate etiologic diagnosis.

Objective: To assess the safety and efficacy of subxiphoid pericardial drainage and pericardiectomy through left anterior thoracotomy for management of massive pericardial effusion.

Material and Method: The medical records of 26 patients with massive pericardial effusion who underwent subxiphoid pericardial drainage or pericardiectomy during the 5 years between 2007
and 2012 in Yala Hospital were reviewd.

Results: There were 16 male and 10 female patients. Age ranged from 9-64 years (mean 33.52±16 years). The causes of pericardial effusions were metastatic cancer in 10 patients, tuberculous
pericarditis in 5 patients, bacterial pericarditis or pyopericardium in 5 patients, and non-specific pericarditis in 6 patients. The diagnosis was made by pericardium biopsy in 17 patients, by culture
in 4 patients, and clinically in 5 patients. Five patients died: one with tuberculous pericarditis who died in hospital, three with lung cancer who died within one year of diagnosis, and one with tuber-
culous pericarditis who died one year after discharge from acquired immune deficiency syndrome (AIDS). All other patients with tuberculous periacrditis and pyopericardium responded well with
treatment.

Conclusion: Subxiphoid pericardial drainage and pericardiectomy through left anterior thoracotomy are safe and effective for management of massive pericardial effusion in both symptomatic relief and getting an accurate etiologic diagnosis, especially in patients with tuberculous pericarditis or malignant tumor invading the pericardium.