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A contemporary look at pericardiocentesis
P R Sinnaeve1, T Adriaenssens1
1Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium.
Insights
Pericardiocentesis, a minimally invasive procedure, is the standard for draining pericardial effusions. Echocardiography and fluoroscopy guidance ensure its safety and effectiveness for diagnosis and treatment.
Area of Science:
- Cardiology
- Interventional Radiology
Background:
- Pericardial effusion management relies on percutaneous drainage.
- Pericardiocentesis is crucial in diverse clinical scenarios, including tamponade relief and diagnostic evaluations.
Purpose of the Study:
- To review the indications and techniques for percutaneous pericardiocentesis.
- To discuss the procedure's role in managing iatrogenic and malignant effusions.
Main Methods:
- Review of current literature on percutaneous pericardiocentesis.
- Discussion of echocardiography and fluoroscopy-guided techniques.
- Analysis of procedural outcomes and recurrence rates.
Main Results:
- Image-guided pericardiocentesis is the standard intervention for pericardial effusion evacuation.
- The procedure is safe and effective when performed by skilled physicians with appropriate imaging.
- Indwelling catheter placement enhances effectiveness and reduces recurrence risk.
Conclusions:
- Percutaneous pericardiocentesis is a safe and effective method for managing pericardial effusions.
- It serves essential diagnostic and therapeutic roles in various clinical settings.
- Skilled performance and imaging guidance are key to successful outcomes.
Abstract:
Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.
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