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At least 19 recordsLinked to original sources
PubMed2003

"Hands-Free" continuous transthoracic monitoring of pericardiocentesis using a novel ultrasound transducer.

BACKGROUND: Pericardiocentesis can be monitored with a hand-held transducer. The purpose of this study was to assess the feasibility of monitoring pericardiocentesis using a novel ultrasound transducer, which can be attached to the chest wall, developed in our laboratory (CONTISON). METHODS: We studied nine patients with large pericardial effusions. The 2.5-MHz transducer is spherical in its distal part and mounted in an external housing to permit steering in 360 degrees. The external housing is attached to the chest wall using an adhesive patch. The CONTISON transducer was placed at the cardiac apex and an apical four-chamber view obtained. Pericardiocentesis was performed from the subcostal position. The pericardial effusion was continuously imaged. Mitral inflow velocity signals were recorded before and after pericardiocentesis. When fluid was first obtained, 50 mL of fluid were discarded after which 5 mL of agitated saline was injected through the needle. RESULTS: In the first patient the pericardiocentesis needle was seen in the left ventricular cavity. Saline injection produced a contrast effect in the left ventricle. The needle was gradually withdrawn until contrast was seen in the pericardial sac. A total of 1100 mL was removed without further complications. The second patient had clear fluid followed by blood stained aspirate. The echocardiogram revealed gradual appearance of granular echoes within the pericardial sac, suggestive of intrapericardial clot that was subsequently surgically evacuated. In the remaining seven patients, agitated saline produced a contrast effect in the pericardial sac indicative of proper needle position. Mitral flow velocity paradoxus was noted in five patients, and it resolved after pericardiocentesis in four patients. No adjustment of the transducer was required. CONCLUSION: The CONTISON transducer permitted continuous monitoring of pericardiocentesis. This technique could potentially facilitate pericardiocentesis.

Adult↗
PubMed1999

Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade.

BACKGROUND: The conventional surgical pericardiotomy and blind needle-puncture pericardiocentesis using a subxiphoid approach have been reported to have only moderate success rates and to be associated with unacceptably high rates of morbidity and mortality. More recently, echocardiographically guided pericardiocentesis was reported to improve considerably the likelihood of success and the safety of this procedure. OBJECTIVE: To evaluate the efficacy and safety of echocardiographically guided pericardiocentesis in the authors' institution. PATIENTS AND METHODS: A series of consecutive patients who underwent percutaneous pericardiocentesis at the Hamilton General Hospital, Hamilton, Ontario, from June 1994 to December 1998. RESULTS: Forty-one patients underwent a total of 46 echocardiographically guided pericardiocentesis procedures. The procedure was successful in 100% of attempts. Clinical complications occurred in two (5%) patients: one patient with known coagulopathy developed hemothorax and one patient developed purulent pericarditis several days after the procedure. There were no deaths, and no patient required urgent referral for surgical management. CONCLUSIONS: Echocardiographically guided pericardiocentesis is safe and effective, and is the method of choice for therapeutic and diagnostic drainage of pericardial effusions. While echocardiographically guided pericardiocentesis was described originally at centres with large volumes of patients with clinically significant pericardial effusions and with extensive experience in using this technique, similar high success and low complication rates were attained at an institution with relatively low numbers of patients requiring pericardial drainage.

Adult↗
PubMed1982

Traumatic pericardiocentesis: two-dimensional echocardiographic visualization of an unfortunate event.

Two-dimensional echocardiography was performed simultaneously with pericardiocentesis in an attempt to visualize the pericardiocentesis needle. Rapid penetration of the right ventricular myocardium by the pericardiocentesis needle occurred and was only appreciated in a slow-motion analysis of the two-dimensional echocardiogram videotape. Development of an intrapericardial thrombus was clearly detected by the two-dimensional echocardiogram videotape. Development of an intrapericardial thrombus was clearly detected by the two-dimensional echocardiogram within 24 hours following this traumatic pericardiocentesis. While two-dimensional echocardiography may offer the possibility for seeing the pericardiocentesis needle, technical considerations may limit the easy visualization of the pericardiocentesis needle and accurate localization of its tip. However, two-dimensional echocardiography may be useful in identifying consequences of suspected or proved traumatic pericardiocentesis procedures.

Adult↗
PubMed1979

The risk of pericardiocentesis.

The risk and potential risk factors of pericardiocentesis were assessed by a review of a series of 52 pericardiocenteses comprising all those performed in the cardiac catheterization laboratory of one institution from 1971 to 1978. On the basis of the operative results, the patients were separated into two groups for comparison; Group I comprised all patients with a successful uncomplicated (35) pericardiocentesis and Group II all those with a nonproductive (16), nontherapeutic (1) or complicated (8) pericardiocentesis. Complications consisted of one death, one cardiac arrest, one aspiration of a subdiaphragmatic abscess and five ventricular punctures without adverse sequelae. Among the patients who had a nonproductive pericardiocentesis, the condition of 11 had probably been misdiagnosed but at least 4 had a false negative pericardiocentesis. Comparison of the two groups showed no significant difference in the incidence of cardiac tamponade or in the clinical presentation based on historical, physical, electrocardiographic, roentgenographic or echocardiographic findings of pericardial disease. Pericardiocentesis was usually successful when performed for suspected malignant pericardial effusion but often unsuccessful when performed for suspected hemopericardium. Anatomically, all patients in Group II had either minimal or loculated posterior pericardial effusion. It is concluded that pericardiocentesis can be performed at a low risk that can be further minimized by consideration of the disease process and the anatomic location of the pericardial fluid.

Adolescent↗
PubMed1998

Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience.

OBJECTIVES: The purpose of this study was to determine the safety and efficacy of rescue echocardiographically guided pericardiocentesis as a primary strategy for the management of acute cardiac perforation and tamponade complicating catheter-based procedures. BACKGROUND: In this era of interventional catheterization, acute tamponade from cardiac perforation as a complication is encountered more frequently. The safety and efficacy of echocardiographically guided pericardiocentesis in this life-threatening situation and outcomes of patients managed by this technique are unknown. METHODS: Of the 960 consecutive echocardiographically guided pericardiocenteses performed at the Mayo Clinic (1979 to 1997), 92 (9.6%) were undertaken in 88 patients with acute tamponade that developed in association with a diagnostic or interventional catheter-based procedure. Most of the patients were hemodynamically unstable at the time of pericardiocentesis, with clinically overt tamponade in 40% and frank hemodynamic collapse (systolic blood pressure <60 mm Hg) in 57%. Clinical end points of interest were the success and complication rates of rescue pericardiocentesis and patient outcomes, including the need for other interventions, clinical and echocardiographic follow-up findings and survival. RESULTS: Rescue pericardiocentesis was successful in relieving tamponade in 91 cases (99%) and was the only and definitive therapy in 82% of the cases. Major complications (3%) included pneumothorax (n=1), right ventricular laceration (n=1) and intercostal vessel injury with right ventricular laceration (n=1); all were treated successfully. Minor complications (2%) included a small pneumothorax and an instance of transient nonsustained ventricular tachycardia; all were resolved spontaneously. Further surgical intervention was performed in 16 patients (18%). No deaths resulted from the rescue pericardiocentesis procedure itself. Early death (<30 days) in this series was due to injuries from cardiac catheter-based procedures (n=3), perioperative complications (n=2) and underlying cardiac diseases (n=2). Clinical or echocardiographic follow-up for a minimum of 3 months or until death (if <3 months) for recurrent effusion or development of pericardial constriction was achieved in 87 (99%) of the patients. CONCLUSIONS: Echocardiographically guided pericardiocentesis was safe and effective for rescuing patients from tamponade and reversing hemodynamic instability complicating invasive cardiac catheter-based procedures. For most patients, this was the definitive and only therapy necessary.

Adolescent↗
PubMed1998

Percutaneous echocardiographically guided pericardiocentesis in pediatric patients: evaluation of safety and efficacy.

The purpose of this study was to evaluate the safety and efficacy of echocardiographically (echo) guided pericardiocentesis in pediatric patients. Echo-guided pericardiocenteses performed in pediatric patients (age >/=16 years) at the Mayo Clinic between 1980 and 1997 were identified. Presentation, cause and characteristics of the effusion, details of the pericardiocentesis procedure, and outcome were determined by comprehensive chart review supplemented by telephone interviews when necessary. Seventy-three pediatric patients, median age 6.7 years (range 1 day to 16 years), underwent 94 consecutive echo-guided pericardiocenteses for effusions of various causes. Twenty-one (22%) procedures were performed in children younger than 2 years. All but 1 procedure were successful (99%). A mean fluid volume of 237 mL (range 4 to 970 mL) was withdrawn. Only a single attempt was needed for entry into the pericardial space in 87 (93%) procedures. No deaths were associated with the pericardiocentesis procedure. Only 1 major complication occurred (1%), a pneumothorax requiring chest tube reexpansion. Three (3%) minor complications-2 instances of right ventricular puncture and a small pneumothorax-did not require treatment. Extended catheter drainage for a mean of 5.2 +/- 4.5 days (range 1 to 19 days) was used with 30 (32%) of the 94 procedures. For the 52 patients who underwent pericardiocentesis without catheter drainage as the initial management strategy, 18 required 21 repeat pericardiocenteses for recurrence of effusion. In contrast, for the 21 patients who had pericardial catheterization as the initial management strategy, none had recurrences necessitating a repeat procedure (P <.001). Increased utilization of a pericardial catheter was associated with a concomitant decrease in the number of surgical pericardial procedures over the study period. Echo-guided pericardiocentesis was the only therapeutic modality for the management of effusion in 73% of all patients. Echo-guided pericardiocentesis is safe and effective in pediatric patients, including children younger than 2 years. The increasing use of pericardial catheterization in conjunction with this technique was associated with significant reduction of recurrence and decreased frequency of surgical interventions for treatment of pericardial effusion. Echo-guided pericardiocentesis with extended catheter drainage should be considered as primary management strategy for clinically significant pericardial effusions in pediatric patients.

Adolescent↗
PubMed1989

Pericardiocentesis guided by a pulse generator.

This study was performed to compare pericardiocentesis guided by a pacing current applied through the pericardiocentesis needle with the traditional method of monitoring ST segment elevation from the needle tip electrogram. ST segment elevation was measured at 3 mm from the epicardium, after epicardial contact, after epicardial penetration and again at 3 mm from the epicardium after epicardial penetration. Two millivolts of ST segment elevation gave the highest combined positive (86%) and negative (79%) predictive value for epicardial contact by the pericardiocentesis needle between the two groups with the largest difference: 3 mm from the epicardium before contact and after epicardial penetration. Therefore, ST segment monitoring cannot reliably determine the point of epicardial contact. To determine the optimal stimulus strength for pulse generator-guided pericardiocentesis, pacing studies were performed using 2, 4, 6, 8 and 10 mA unipolar stimulus strengths. The pacing studies were performed both with and without a hemodynamically significant pericardial effusion to determine if increased pericardial pressure altered the pacing threshold. A 4 mA unipolar cathodal stimulus was chosen because it captured the ventricle only with direct contact of the epicardium. Ten dogs were instrumented and cardiac tamponade produced so that a subxiphoid approach to the epicardium with the pacing needle electrode could be attempted. During pericardiocentesis, needle tip electrograms were recorded, alternating with pacing attempts using a 4 mA unipolar stimulus. In all 10 dogs, the effusion was entered and epicardium was contacted as indicated by capture. No myocardial perforation or coronary artery or venous injuries were produced. These findings support the use of a pulse generator to guide pericardiocentesis.

Animals↗
PubMed1994

Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful?

BACKGROUND: Cardiac tamponade frequently complicates acute proximal aortic dissection and is one of the most common causes of death from aortic dissection. Well-defined strategies for the management of acute aortic dissection now exist; however, little is known about how best to manage the hemopericardium that may complicate it. METHODS AND RESULTS: Using a computer-based review, we retrospectively identified 10 patients presenting to our hospital over a 13-year period who were diagnosed with both aortic dissection and cardiac tamponade. All 10 had proximal dissections. Three of the 10 presented as the sudden onset of fatal electromechanical dissociation, 6 presented with hypotension, and 1 was normotensive on presentation. Of the 7 hypotensive or normotensive patients diagnosed with cardiac tamponade, 4 underwent successful pericardiocentesis while awaiting surgery. At time intervals of 5 to 40 minutes after their pericardiocenteses, 3 of the 4 patients experienced sudden onset of electromechanical dissociation and death; the fourth patient survived and underwent surgical repair. Of the 3 hypotensive or normotensive patients who had either no pericardiocentesis or an unsuccessful pericardiocentesis, all 3 underwent successful surgical repair and survived. CONCLUSIONS: In this study, patients with an aortic dissection complicated by cardiac tamponade have an early mortality of 60%. While 3 of the 10 died from electromechanical dissociation immediately upon presentation, the 3 other deaths all occurred shortly after successful pericardiocentesis, a procedure undertaken to stabilize them. While the number of patients in this series is small, the observations do raise the possibility that in patients with cardiac tamponade complicating aortic dissection pericardiocentesis could be harmful rather than beneficial. Possible mechanisms for why the performance of pericardiocentesis might destabilize such patients are proposed.

Aged↗
PubMed2000

Pericardiocentesis: differential aspects of a common procedure.

OBJECTIVE: To evaluate the risk and effectiveness of pericardiocentesis in primary and repeat cardiac tamponade. DESIGN: Retrospective analysis. SETTING: Intensive care unit in a medical university hospital. PATIENTS: Sixty-three consecutively admitted patients with cardiac tamponade. INTERVENTIONS: In all patients pericardiocentesis was performed via the subxiphoid pathway after echocardiographic detection of the pericardial effusion. MEASUREMENTS AND RESULTS: There was no adverse event in patients undergoing primary pericardiocentesis, which was sufficient to resolve pericardial effusion in 51 of 63 patients (81%). However, repeat pericardiocentesis necessitated by the recurrence of symptomatic pericardial effusion yielded suboptimal results in 10 of 12 patients (83%). CONCLUSION: Pericardiocentesis is the treatment of choice for primary symptomatic pericardial effusion. In recurrent pericardial effusion surgical approaches appear to be preferable.

Adult↗
PubMed2002

Catheter pericardiocentesis for delayed tamponade after cardiac valve operation.

BACKGROUND: Late tamponade is a rare cause of morbidity and mortality after cardiac valve operation. We describe our recent experience with this entity. METHODS: This is a single institution, procedure-matched, retrospective review of patients undergoing pericardiocentesis more than 7 days after cardiac operation, during a 7-year period. RESULTS: Pericardiocentesis for delayed tamponade was performed in 43 of 9,612 patients. Although isolated valve operation accounted for 17% of all patients overall, 76% of patients undergoing pericardiocentesis (33 of 43) had undergone isolated valve operation. The average age in this group was 58 years, compared to an average of 68 years in all patients. Patients presented with tamponade an average of 18 days after operation. Positive predictors included elevated prothrombin time on presentation. Of the patient cohort 75% presented with dyspnea, 61% with inability to diurese, and 61% with hypotension. Echocardiography detected effusions in all patients, but specific echocardiographic signs of tamponade were present in only 30%. Of the patients, 97% were successfully treated by pericardiocentesis. All were safely restarted on warfarin. One patient required pericardial window. CONCLUSIONS: Delayed cardiac tamponade is more common after isolated valve operation, as opposed to coronary artery bypass grafting and valve/coronary artery bypass grafting. It tends to occur in the third postoperative week in younger patients who are aggressively anticoagulated. Pericardiocentesis with catheter placement is highly effective, and patients can be reanticoagulated safely. This series underestimates the incidence of late tamponade, as some patients may present to outside facilities. The diagnosis is aided by a high degree of suspicion.

Adult↗
PubMed2004

Clinical and echocardiographic characteristics of pericardial effusion in patients who underwent echocardiographically guided pericardiocentesis: Yonsei Cardiovascular Center experience, 1993-2003.

Percutaneous pericardiocentesis guided by two-dimensional echocardiography was introduced in 1983 as an alternative to electrocardiographically or fluoroscopically guided puncture for the management of pericardial effusion. The objective of this study was to investigate echocardiographically (echo)- guided pericardiocenteses performed at Yonsei Cardiovascular Center from January 1, 1993 to December 31, 2003, and also to determine whether patient profiles, etiology, and practice patterns have changed over this 11-year period. The medical records of 272 patients were examined and a follow-up survey was conducted. Patient clinical profiles, etiology, echocardiographic findings, and procedural details were determined for 2 periods: January, 1993 through December, 1997 (period 1); and January 1998 through December, 2003 (period 2). During the 11-year study period, 291 therapeutic, echo-guided pericardiocenteses with pericardial catheter drainage were performed in 272 patients. The number of pericardiocentesis in period 2 was increased compared with period 1 (191 cases vs. 100 cases). The mean age at pericardiocentesis increased from 49 +/- 17 years in period 1 to 55 +/- 16 years in period 2 (p < 0.05). The procedural success rate was 99% overall with a major complication rate of 0.7% (2 cases of right ventricular free wall perforation which required emergency operation). Only one procedure-related mortality (< 30 days) was noted. Malignancy was the leading cause of a pericardial effusion requiring pericardiocentesis (45.6%). The incidence of pericardial effusion following cardiothoracic surgery and percutaneous coronary intervention procedures accounted for nearly 20% of all pericardiocenteses performed. Echo-guided pericardiocentesis has become a safe, standard practice for clinically significant pericardial effusion, in line with the changes of patients profiles over the 11 years of the study.

Adult↗
PubMed1993

Percutaneous pericardiocentesis versus subxiphoid pericardiotomy in cardiac tamponade due to postoperative pericardial effusion.

In a retrospective study, 42 patients with acute cardiac tamponade due to pericardial effusion were evaluated following cardiac surgery, and the pericardial fluid was drained by one of two alternative methods: two-dimensional echocardiographic-guided pericardiocentesis (2D-echo) or subxiphoid surgical pericardiotomy. During the first period (from 1982 to 1986), one of the two methods was chosen by the treating physicians, whereas in the second period (from 1986 to 1991), 2D-echo-guided pericardiocentesis was the treatment of choice. Percutaneous pericardiocentesis was performed using local anesthesia in 29 patients. A Tuohy needle was inserted at the left xipho-costal junction and, when fluid was obtained, 6 mL of saline solution was injected during 2D-echo contrast monitoring, and a multiple-hole, 6F, 30-cm catheter was inserted by means of a guidewire and positioned into the posterior pericardium, as near as possible to the atrioventricular groove. Complete drainage of pericardial fluid by percutaneous pericardiocentesis was obtained in 26 patients (89%). This procedure also allowed the evacuation of posterior and loculated effusions. Complications included two right ventricular punctures, which were immediately recognized by 2D-echo contrast and produced no serious consequences. Sixteen patients who underwent surgical pericardiotomy had complete evacuation of pericardial fluid without major complications (two of them suffered atrial arrhythmias during the procedure). The average amount of fluid drained, as well as the localization of the effusions, were the same for both groups. 2D-echo-guided pericardiocentesis was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to subxiphoid pericardiotomy for cardiac tamponade due to postoperative pericardial effusions.

Adult↗
PubMed1979

Cardiac tamponade following penetrating mediastinal injuries: improved survival with early pericardiocentesis.

UNLABELLED: Cardiac tamponade was diagnosed in 197 patients admitted over 20 years (1955-1974) to the Charity Hospital of New Orleans, for emergency treatment of pentrating mediastinal injuries. Of the 197, 174 definitively treated patients followed one of three patterns of management: 96 had OR thoracotomy, 68% were unstable, and preoperative pericardiocentesis reduced mortality from 25 to 11% (p less than 0.01); 44 had emergency thoracotomy, 91% were unstable, and prethoractomy pericardiocentesis decreased mortality from 94 to 63% (p less than 0.05); 34 patients primarily with isolated stab wounds, were treated nonsurgically with pericardiocentesis and observation, only 50% were unstable and there was 15% mortality. Recurrent tamponade did not significantly increase overall or operative mortality in patients with pericardiocentesis. RECOMMENDATIONS: early, even presumptive, diagnosis of tamponade; immediate pericardial decompression via pericardiocentesis; and rapid transfer to OR for thoracotomy or sternotomy and cardiorrhaphy with continous pericardial decompression via intrapericardial catheter.

Adolescent↗
PubMed1999

Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998.

STUDY OBJECTIVES: This study assessed the clinical features, timing of presentation, and echocardiographic characteristics associated with clinically significant pericardial effusions after cardiothoracic surgery. The outcomes of echocardiographically (echo-) guided pericardiocentesis for the management of these effusions were evaluated. DESIGN: From the prospective Mayo Clinic Registry of Echo-guided Pericardiocentesis (February 1979 to June 1998), 245 procedures performed for clinically significant postoperative effusions were identified. Clinical features, effusion causes, echocardiographic findings, and management outcomes were studied and analyzed. Cross-referencing the registry with the Mayo Clinic surgical database provided an estimate of the incidence of significant postoperative effusions and the number of cases in which primary surgical management was chosen instead of pericardiocentesis. RESULTS: Use of anticoagulant therapy was considered a significant contributing factor in 86% and 65% of early effusions (< or =7 days after surgery) and late effusions (>7 days after surgery), respectively. Postpericardiotomy syndrome was an important factor in the development of late effusions (34%). Common presenting symptoms included malaise (90%), dyspnea (65%), and chest pain (33%). Tachycardia, fever, elevated jugular venous pressure, hypotension, and pulsus paradoxus were found in 53%, 40%, 39%, 27%, and 17% of cases, respectively. Transthoracic echocardiography permitted rapid diagnosis and hemodynamic assessment of all effusions except for three cases that required transesophageal echocardiography for confirmation. Echo-guided pericardiocentesis was successful in 97% of all cases and in 96% of all loculated effusions. Major complications (2%), including chamber lacerations (n = 2) and pneumothoraces (n = 3), were successfully treated by surgical repair and chest tube reexpansion, respectively. Median follow-up duration for the study population was 3.8 years (range, 190 days to 16.4 years). The use of extended catheter drainage was associated with reduction in recurrence for early and late postoperative effusions by 46% and 50%, respectively. CONCLUSIONS: The symptoms and physical findings of clinically significant postoperative pericardial effusions are frequently nonspecific and may be inadequate for a decision regarding intervention. Echocardiography can quickly confirm the presence of an effusion, and pericardiocentesis under echocardiographic guidance is safe and effective. The use of a pericardial catheter for extended drainage is associated with lower recurrence rates, and the majority of patients so treated do not require further intervention.

Adolescent↗
PubMed1994

Effect of pericardiocentesis on circulating concentrations of atrial natriuretic hormone and arginine vasopressin in dogs with spontaneous pericardial effusion.

Factors regulating the secretion of atrial natriuretic hormone (ANH) and arginine vasopressin (AVP) have not been elucidated fully. In several studies the release of these peptides has been studied by inducing both increased atrial pressure and atrial distension. A few studies employ cardiac tamponade, allowing the effect of atrial pressure and atrial stretch to be studied separately. In eleven dogs with spontaneous cardiac tamponade the effect of pericardiocentesis on circulating concentrations of ANP and AVP was studied. Pericardiocentesis was followed by a prompt rise in (non-elevated) plasma ANH concentrations from 21.6 +/- 7.3 to 65.4 +/- 17.1 pmol/l (mean +/- SEM). The initially slightly elevated AVP concentration of 5.5 +/- 1.5 pmol/l declined following pericardiocentesis to 2.1 +/- 0.5 pmol/l. In three dogs the systolic arterial pressure was measured indirectly and the central venous pressure was measured with a fluid-filled catheter. Before and after pericardiocentesis arterial pressure readings did not change significantly. Central venous pressure values showed an immediate very steep significant decrease after centesis. It is concluded that ANH release is primarily regulated by stretch and not by atrial pressure, that plasma AVP concentrations are moderately elevated in cardiac tamponade and that in cardiac tamponade pericardiocentesis causes a rapid decline in plasma AVP concentration.

Animals↗
PubMed1991

Pericardiocentesis for symptomatic malignant pericardial effusion: a study of 36 patients.

We reviewed 36 cases of symptomatic malignant pericardial effusion managed with pericardiocentesis at our institution from 1982 to 1989. There were 13 men and 23 women, aged 49 +/- 12 years (range, 33-76 years). The commonest underlying tumours were lung cancer (12 cases, 33%) and breast cancer (11 cases, 30%). Pericardiocentesis was successful as the initial management in 34 of 36 patients (94%); one patient died as a result of the procedure and another required subxiphoid incision and tube drainage of the effusion. When intrapericardial sclerotherapy was performed, only three of 28 patients required repeat pericardiocentesis, and when sclerotherapy was not performed initially, four of seven patients had recurrent symptomatic effusions. Median survival following pericardiocentesis in breast cancer patients was 10 months (range, 0-36 months) and in all other malignancies was four months (range, 0-12 months). We conclude that pericardiocentesis with intrapericardial sclerotherapy provides good local control for symptomatic malignant pericardial effusion in the majority of patients. In spite of this, the median survival of such patients is poor, especially in patients with malignancies other than breast cancer, with few patients surviving more than a few months.

Adult↗
PubMed1985

Pericardiocentesis using echocardiography.

Echocardiography is the procedure of choice for the detection and localization of pericardial effusion. It should be performed in all patients prior to elective pericardiocentesis to confirm the diagnosis and to determine the size and location of the effusion in order to minimize the risk and to maximize the yield of pericardiocentesis. When pericardial tamponade is suspected, echocardiography should be performed, time permitting, to document the presence of effusion, because other clinical entities, such as right ventricular failure, may mimic tamponade. Additionally, the finding of diastolic posterior motion of the right ventricular wall, or "diastolic collapse" of the right ventricle, is further evidence for the presence of tamponade and, at times, may eliminate the need for invasive hemodynamic diagnosis. Echocardiography is also useful when performed during pericardiocentesis, to evaluate the size and location of the effusion as the procedure progresses. Contrast echocardiography can determine the position of the pericardiocentesis needle quickly and safely. Thus the appropriate use of echocardiography has increased the safety and improved the yield of diagnostic and therapeutic pericardiocentesis.

Cardiac Tamponade↗
PubMed2000

Subxiphoid pericardiocentesis guided by contrast two-dimensional echocardiography in cardiac tamponade: experience of 110 consecutive patients.

AIMS: We evaluated echo-guided pericardiocentesis with contrast study in cardiac tamponade management. PATIENTS AND METHODS: From 1982 to 1998 we performed pericardiocentesis in 110 patients (56 +/- 14 years old). Subxiphoid approach was used in 109. Cardiac tamponade was idiopathic (n = 16), secondary to malignant disease (n = 50) and miscellaneous disorders (n = 44). RESULTS: Pericardial fluid was bloody (n=75), serous (n = 29) or turbid (n = 6). Mean volume of fluid removed was 585 +/- 370 ml. When prolonged drainage (60 +/- 26 h) was used (n = 41), total effusion volume was 850 +/- 340 ml. Eleven deaths were observed during the early period following pericardiocentesis. No relation with procedure was demonstrated by autopsy in 10, and death always occurred in critically-ill patients (five malignant diseases, five cardiac ruptures and one septic shock). Other complications were: right ventricular puncture (n = 11) with deleterious effect in one, vasovagal hypotension (n = 6) and paroxysmal arrhythmia (n = 6). Surgical drainage was mandatory in 19 patients. It had to be done as an emergency (within 6 h), because of failure of the procedure in four patients. In 14 patients without prolonged drainage a delayed surgical evacuation was indicated, because of persistent (n = 3) or recurrent (n = 11) cardiac tamponade. Only one surgical procedure was required after prolonged drainage. CONCLUSIONS: Echo-guided pericardiocentesis with contrast study is an effective technique which reduces the risk of cardiac tamponade management. It should be considered in patients with critical haemodynamic condition or advanced malignancy, and in patients with poor short-term prognosis.

Adult↗