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Transcardiac pericardiocentesis: an emergency life-saving technique for cardiac tamponade
Li-Fern Hsu1, Chroistophe Scavée, Pierre Jaïs
1Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France. hsulifern@mac.com
Insights
A novel transcardiac approach offers rapid pericardial drainage when standard pericardiocentesis fails in cardiac tamponade. This technique can be life-saving in critically unstable patients, preventing fatal delays.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Cardiac tamponade is a severe complication of catheter-based cardiac procedures.
- Percutaneous pericardiocentesis is the standard treatment, but surgical drainage is needed for failures.
- Rapid intervention is critical in collapsed patients to prevent fatal outcomes.
Observation:
- A patient with procedure-related acute cardiac tamponade rapidly deteriorated and experienced cardiorespiratory arrest.
- Conventional pericardiocentesis failed to provide adequate pericardial drainage.
- A novel transcardiac approach using a transseptal puncture kit was employed for rapid drainage.
Findings:
- The transcardiac approach successfully achieved life-saving pericardial drainage in a critically unstable patient.
- Subsequent surgical repair of the cardiac perforation was performed.
- The patient survived without sequelae, highlighting the efficacy of the adjunctive technique.
Implications:
- The transcardiac approach represents a potentially life-saving adjunctive technique for managing cardiac tamponade.
- This method is particularly valuable in rapidly deteriorating or extremely unstable patients unresponsive to conventional treatment.
- It offers a rapid alternative when immediate surgical intervention is not feasible or timely.
Abstract:
Life-threatening cardiac tamponade is one of the most serious complications of catheter-based cardiac procedures. Although most cases can be effectively treated by percutaneous pericardiocentesis, urgent surgical drainage is required in unsuccessful cases. Rarely, in collapsed patients, the delay for surgery, however minimal, may be fatal. We describe a technique whereby life-saving pericardial drainage was rapidly achieved via a novel transcardiac approach, using the transseptal puncture kit, after failure of conventional pericardiocentesis in a patient with procedure-related acute tamponade who rapidly deteriorated and developed cardiorespiratory arrest within a few minutes. Although surgical repair for the perforation had to be performed subsequently, the patient survived without sequelae. This transcardiac approach may be an important and potentially life-saving adjunctive technique after failure of conventional pericardiocentesis in rapidly deteriorating or extremely unstable patients.