Permanent Catheter Placement for Recurrent Pericardial Effusions in the Presence of Dense Adhesions and Loculations

Pericardial effusion (PcE) represents a spectrum of clinical presentations, ranging from incidental findings to life-threatening cardiac tamponade. While pericardiocentesis and surgical pericardial window are considered typical management approaches, recurrent and refractory cases in medically complex patients present unique challenges. Permanent indwelling catheters (PiCs), which are widely used for pleural effusions, have rarely been applied in the pericardial space. We describe the case of a 36-year-old woman with cerebral palsy, Pierre Robin syndrome, and a history of recurrent PcE and pleural effusions after failed pericardiocentesis and pericardial window. Given her complicated anatomy and comorbidities, a video-assisted thoracic surgery pericardial window with PiC placement was attempted. The effusion was heavily loculated and viscous, limiting catheter efficacy; drainage remained minimal, and the device was removed one month later. This case highlights both the potential role and limitations of PiCs for managing recurrent or refractory PcE.