• comparison of the evolution between day 1 and day 14 of the mean echocardiographic score of pericardial effusion between treated and untreated (placebo) groups
  

•  Number of tamponades
  
•  Number of patients in whom the individual echographic grade is decreasing of at least one point
  
•  Number of pericardiotomy
  
•  Creatinemia
  
•  Haemoglobinemia
  
•  PE evolution in patients having an inflammatory syndrome (C reactive Protein >30)
  
•  PE evolution in patients receiving a vitamin K antagonist
  

Following cardiac surgery, the incidence of Pericardial effusion (PE) is high (50-85%) . The risk of tamponade is well acknowledged : about 2%. We published in 2004 in CHEST a study which allows us to know the natural history of post-operative PE and to validate, for the first time the use of an echocardiographic classification for predicting the occurrence of a tamponade. NSAID are widely used in this setting, but no study has ever been conducted trying to assess their efficiency. The aim of the study is therefore obvious : must we use NSAID in order to prevent post operative cardiac tamponades ?. In order to answer this question, we are going to conduct a double-blind randomized study comparing diclofenac to a placebo.

Every patient hospitalized in a post operative cardiac rehabilitation center less than 30 days after cardiac surgery and presenting at the first TTE (Trans Thoracic cardiac Echography) a PE of severity > 2 (that is to say about 10 % of the totality of the patients having undergone a cardiac operation) will be included.: after randomisation, patients will receive a placebo or diclofenac (50 mg ) bid, in a double blind way, during 14 days. Trans thoracic cardiac echography, creatininemia, haemoglobinemia, International Normalized Ratio (for patients receiving a vitamin K antagonist) will be performed once a week during 2 weeks. Clinical assessment will be done every day (there will be no outpatient

Primary end point : evolution of the mean echocardiographic score in each group

• Secondary end-points :

  • Number of tamponades
  • Number of patients in whom the individual echographic grade is decreasing of at least one point
  • Number of pericardiotomy
  • Creatininemia Haemoglobinemia
  • PE evolution in patients having an inflammatory syndrome (C reactive Protein >30)

  • PE evolution in patients receiving a vitamin K antagonist

    86 patients per group are necessary; therefore we will include a total of 200 patients