Cor Vasa 2015, 57(4):e239-e244 | DOI: 10.1016/j.crvasa.2015.07.001

Pericardiocentesis guided by echocardiography performed in echocardiography laboratory - Safety profile of the single centre prospective registry

Wael El-Husseini^*, Alena Pravečková, Radka Kočková, Tomáš Marek, Petr Frídl, Josef Kautzner

Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction: Pericardiocentesis is an invasive procedure for treatment of large pericardial effusion or cardiac tamponade and for diagnostics of pericardial effusion of unknown origin. Fluoroscopy navigation has been the preferred method during last decades. Nevertheless, new imaging methods such as echocardiography emerged as an alternative guiding method for pericardiocentesis. These methods may improve safety of the procedure.

Methods: All consecutive pericardiocenteses performed in noninvasive cardiology department of a tertiary cardiovascular centre during the period between 1998 and 2012 were prospectively recorded. We focused on the procedural safety and procedural success rate.

Results: During 15 years period, 253 pericardiocenteses were performed in 185 patients. Most of the procedures (240 cases) were performed under echocardiographic control in our non-invasive cardiology laboratory with strictly sterile conditions and equipment for cardiopulmonary resuscitation on site. Etiology of effusion was heart transplantation in 38 patients (25%), postoperative in 20 patients (14%), infective pericarditis in 25 patients (16%), malignancy in 18 patients (12%), invasive procedures in 19 patients (8%). Apical approach was the most frequent in 218 patients (92%), parasternal in 13 patients (5%) and subxiphoideal in 7 patients (3%). The procedural success rate was 97% overall, with a total complication rate of 3% (two major complications [0.3%]; seven minor complications [2.7%]). Minor complications included two cases of small pneumothorax, two cases of pericardial fluid drainage into pleural space, two cases of transient right chamber entries, and in one case the procedure was complicated by hemopericardium without the need for surgical management. Major complications included two cases due to ventricular perforation, one with left ventricle wall laceration in a loculated effusion and one complication due to right ventricular laceration, both resulting in hemopericardium and required emergency surgical repair.

Conclusion: Echocardiography guided pericardiocentesis performed by echocardiologists in noninvasive cardiology department under strictly sterile conditions and equipment for cardiopulmonary resuscitation is a safe procedure with infrequent complications. Apical entry site is safe and dominant approach for pericardiocentesis under echocardiographic navigation.

Keywords: Complications of pericardiocentesis; Pericardial effusion; Pericardial tamponade

Received: February 20, 2015; Revised: June 30, 2015; Accepted: July 1, 2015; Published: August 1, 2015  Show citation