A Transesophageal Cardiovascular Intervention

Area of Science:

• Cardiology
• Gastroenterology
• Interventional Radiology

Background:

• Pericardial effusion can lead to cardiac tamponade, a life-threatening condition.
• Posteriorly located pericardial effusions pose a challenge for standard transthoracic drainage.
• Recurrent breast adenocarcinoma is a potential cause of pericardial effusion.

Observation:

• A 58-year-old woman with recurrent breast cancer presented with dyspnea due to cardiac tamponade.
• The pericardial effusion was located posteriorly, making transthoracic pericardiocentesis unsuitable.
• Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed.

Findings:

• The pericardial sac was successfully punctured using a 19-gauge needle.
• 245 mL of pericardial fluid were aspirated.
• The procedure resolved the tamponade physiology, alleviating dyspnea.

Implications:

• Endoscopic ultrasonography-guided transesophageal drainage is a viable and novel therapeutic option.
• This technique expands treatment possibilities for challenging pericardial effusions.
• It offers a minimally invasive approach for posterior effusions unresponsive to conventional methods.