New nonsurgical technique for multiple pericardial biopsies.

Area of Science:

• Cardiology
• Interventional Radiology
• Pathology

Background:

• Pericardial effusion diagnosis often requires invasive procedures.
• Nonsurgical biopsy techniques for the pericardium are limited.
• Accurate histological and microbiological analysis is crucial for effective treatment.

Purpose of the Study:

• To present a new, nonsurgical technique for obtaining multiple pericardial biopsies.
• To evaluate the diagnostic yield and safety of this novel biopsy method.

Main Methods:

• A Seldinger technique was used to introduce a catheter via a subxiphoid approach under fluoroscopy.
• Pericardial fluid was aspirated, and the catheter was replaced by a curved Teflon sheath.
• A bioptome was inserted through the sheath for tissue sampling, with air introduced into the pericardium to outline the parietal pericardium.

Main Results:

• Eighteen patients underwent the procedure, yielding an average of eight pericardial tissue samples per patient.
• Histological examination revealed malignancy in three patients and tuberculous granuloma in six.
• Mycobacterium tuberculosis was cultured from six tissue specimens, with acid-fast bacilli identified in four tissue smears; fluid analysis was negative in all cases.
• The biopsy provided diagnostic information in nine out of ten patients with thickened pericardium.

Conclusions:

• This nonsurgical technique allows for safe and effective acquisition of multiple pericardial biopsies.
• The method significantly improves diagnostic yield for conditions like malignancy and tuberculosis compared to fluid analysis alone.
• The procedure demonstrated no complications in the study cohort.