Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure

Published:February 03, 2016DOI:
      Pericardiocentesis is useful in the diagnosis and treatment of pericardial effusive disease. To date, a number of methods have been developed to reduce complications and increase the success rate of the procedure. The aim of the present study was to evaluate the efficacy and the safety of echocardiography-guided pericardiocentesis under continuous echocardiographic monitoring in the management of pericardial effusion. We prospectively performed 161 pericardiocentesis procedures in 141 patients admitted from 1993 to 2015 in 3 centers. This procedure was performed for tamponade or large pericardial effusion in 157 cases and for diagnosis in 4 cases. A percutaneous puncture was performed where the largest amount of fluid was detected. To perform a real-time echo-guided procedure, a multi-angle bracket was mounted on the echocardiographic probe to support the needle and enable its continuous visualization during the puncture. The procedure was successful in 160 of 161 cases (99%). Two major complications occurred (1.2%): 1 mediastinal hematoma that required surgical drainage in a patient on anticoagulant therapy and 1 pleuropericardial shunt requiring thoracentesis. Seven minor complications occurred (4.3%): 1 pleuropericardial shunt, 1 case of transient AV type III block, 3 vasovagal reactions (1 with syncope), and 2 cases of acute pulmonary edema managed with medical therapy. No punctures of any cardiac chamber occurred, and emergency surgical drainage was not required in any case. In conclusion, echocardiography-guided pericardiocentesis under continuous visualization is effective, safe, and easy to perform, even in hospitals with low volumes of procedures with or without cardiac surgery.
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        • Spodick D.H.
        The Pericardium: A Comprehensive Textbook.
        Marcel Dekker, New York1997
        • Roble S.L.
        • Hoit B.D.
        Diseases of the pericardium.
        in: O'Rourke R.A. Walsh R.A. Fuster V. Hurst's the Heart Manual of Cardiology. 12th ed. McGraw-Hill Medical, New York2009: 524-529
        • Fagan S.M.
        • Chan K.L.
        Pericardiocentesis. Blind no more!.
        Chest. 1999; 116: 275-276
        • Callahan J.A.
        • Seward J.B.
        • Nishimura R.A.
        • Miller F.A.
        • Reeder G.S.
        • Shub C.
        • Callahan M.J.
        • Schattenberg T.T.
        • Tajik A.J.
        Two-dimensional Ecocardiographically guided pericardiocentesis: experience in 117 consecutive patients.
        Am J Cardiol. 1985; 55: 476-479
        • Tsang T.S.
        • Enriquez-Sarano M.
        • Freeman W.K.
        • Barnes M.E.
        • Sinak L.J.
        • Gersh B.J.
        • Bailey K.R.
        • Seward J.B.
        Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years.
        Mayo Clin Proc. 2002; 77: 429-436
        • Maggiolini S.
        • Bozzano A.
        • Russo P.
        • Vitale G.
        • Osculati G.
        • Cantù E.
        • Achilli F.
        • Valagussa F.
        Echocardiography-guided pericardiocentesis with probe-mounted needle: report of 53 cases.
        J Am Soc Echocardiogr. 2001; 14: 821-824
        • Sagristà-Sauleda J.
        • Angel J.
        • Sambola A.
        • Permanyer-Miralda G.
        Hemodynamic effects of volume expansion in patients with cardiac tamponade.
        Circulation. 2008; 117: 1545-1549
        • Weitzman L.B.
        • Tinker W.P.
        • Kronzon I.
        • Cohen M.L.
        • Glassman E.
        • Spencer F.C.
        The incidence and natural history of pericardial effusion after cardiac surgery—an echocardiographic study.
        Circulation. 1984; 69: 506-511
        • Armstrong W.F.
        • Schilt B.F.
        • Helper D.J.
        • Dillon J.C.
        • Feigenbaum H.
        Diastolic collapse of the right ventricle with cardiac tamponade: an echocardiographic study.
        Circulation. 1982; 65: 1491-1496
        • Gillam L.D.
        • Guyer D.E.
        • Gibson T.C.
        • King M.E.
        • Marshall J.E.
        • Weyman A.E.
        Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade.
        Circulation. 1983; 68: 294-301
        • Appleton C.P.
        • Hatle L.K.
        • Popp R.L.
        Cardiac tamponade and pericardial effusion: respiratory variation in transvalvular flow velocities studied by Doppler echocardiography.
        J Am Coll Cardiol. 1988; 11: 1020-1030
        • Himelman R.B.
        • Kircher B.
        • Rockey D.C.
        • Schiller N.B.
        Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade.
        J Am Coll Cardiol. 1988; 12: 1470-1477
        • Lindenberg M.
        • Kjellberg M.
        • Karlsson E.
        • Wranne B.
        Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion.
        J Intern Med. 2003; 253: 411-417
        • Akyuz S.
        • Zengin A.
        • Arugaslan E.
        • Yazici S.
        • Onuc T.
        • Ceylan U.S.
        • Gungor B.
        • Gurkn U.
        • Kemaloglu O.T.
        • Kasikcioglu H.
        • Cam N.
        Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion. Outcomes over a 10-year period.
        Herz. 2015; 40: 153-159
        • Vayre F.
        • Lardoux H.
        • Pezzano M.
        • Bourdarias J.P.
        • Dubourg O.
        Subxiphoid pericardiocentesis guided by contrast two-dimensional echocardiography in cardiac tamponade: experience of 110 consecutive patients.
        Eur J Echocardiogr. 2000; 1: 66-71
        • Chandraratna P.A.
        • Reid C.L.
        • Nimalasuriya A.
        • Kawanishi D.
        • Rahimtoola S.H.
        Application of 2-dimensional contrast studies during pericardiocentesis.
        Am J Cardiol. 1983; 52: 1120-1122
        • Callahan J.A.
        • Seward J.B.
        • Tajik A.J.
        Cardiac tamponade: pericardiocentesis directed by two-dimensional echocardiography.
        Mayo Clinic Proc. 1983; 60: 340-347
        • Chandraratna P.A.
        Uses and limitation of echocardiography in the evaluation of pericardial disease.
        Echocardiography. 1984; 1: 55-74
        • Bernal J.M.
        • Afonso L.
        • Pradhan J.
        • Li T.
        Acute pulmonary edema following pericardiocentesis for cardiac tamponade.
        Can J Cardiol. 2007; 23: 1155-1156
        • Imazio M.
        Pericardial decompression syndrome: a rare but potentially fatal complication of pericardial drainage to be recognized and prevented.
        Eur Heart J Acute Cardiovasc Care. 2015; 4: 121-123
        • Ristić A.D.
        • Imazio M.
        • Adler Y.
        • Anastasakis A.
        • Badano L.P.
        • Brucato A.
        • Caforio A.L.
        • Dubourg O.
        • Elliott P.
        • Gimeno J.
        • Helio T.
        • Klingel K.
        • Linhart A.
        • Maisch B.
        • Mayosi B.
        • Mogensen J.
        • Pinto Y.
        • Seggewiss H.
        • Seferovic P.M.
        • Tavazzi L.
        • Tomkowski W.
        • Charron P.
        Triage strategy for urgent management of cardiac tamponade: a position statement of the european society of cardiology Working Group on Myocardial and pericardial diseases.
        Eur Heart J. 2014; 35: 2279-2284
        • LeWinter M.M.
        • Tiscler M.D.
        Pericardial diseases.
        in: Bonow R. Mann D. Zippes D.P. Libby P. Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. WB Saunders, Philadelphia2012: 1651-1671