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Chronic percutaneous pericardial drainage with modified pigtail catheters in children
Insights
Modified pigtail catheters provide safe and effective chronic pericardial drainage in children. Adding side holes prevents clotting, eliminating the need for heparin and subsequent interventions.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Pericardial effusion in children can lead to cardiac tamponade, requiring drainage.
- Traditional pericardiocentesis may be insufficient for chronic effusions.
- Percutaneous drainage offers a less invasive approach.
Purpose of the Study:
- To evaluate the safety and efficacy of chronic percutaneous pericardial drainage using pigtail catheters in pediatric patients.
- To identify modifications needed for effective long-term catheter patency.
Main Methods:
- Seven pediatric patients (0.5-16 years) with pericardial effusion underwent percutaneous drainage.
- Initial attempts used unmodified angiography pigtail catheters.
- Subsequent patients received modified 8Fr catheters with added distal side holes.
Main Results:
- Unmodified catheters clotted within 36 hours or required heparin infusions.
- Modified catheters with side holes remained patent for 3-7 days without heparin.
- No complications or need for further drainage occurred with modified catheters.
Conclusions:
- Percutaneous pericardial drainage is a safe and effective option for pediatric patients.
- Modifying pigtail catheters with adequate side holes is crucial for chronic drainage success.
- This technique avoids complications and the need for operative intervention.
Abstract:
To determine the safety and efficacy of chronic percutaneous pericardial drainage in children, pigtail catheters were inserted over curved guidewires under fluoroscopic control into the pericardial space in 7 consecutive children with pericardial effusion. Pericardiocentesis was therapeutic (for tamponade) in 1 child, diagnostic in 4 and both therapeutic and diagnostic in 2. The children were 0.5 to 16 years old and weighed 5 to 65 kg. Underlying diagnoses included cancer (3 children), congenital heart disease (2 children) and immunodeficiency and hemolytic uremic syndrome (1 each). When unmodified pigtail catheters, designed for angiography, were used (as in the first 3 children), either the catheters clotted within 36 hours, necessitating operative pericardial drainage, or repeated heparin infusions were required to keep the catheter patent. However, when 8Fr catheters were modified by placing 0.050-inch side holes along the distal shaft, the catheters remained patent and effectively drained the pericardial space for 3 to 7 days. Heparin infusion was not required, no child managed with the modified catheters required subsequent drainage and no complications occurred. In conclusion, percutaneous pericardial drainage is safe, even in small children, and can be effective chronically if catheters with large drainage holes are used.