Diagnosis and treatment of pericarditis by the subxiphoid approach

The subxiphoid approach for the diagnosis and treatment of pericarditis was used in 49 patients. Various diagnoses were established in 43 cases, and drainage was accomplished in 46. One patient died as a direct consequence of the procedure. Accidental right pneumothorax occurred in three cases. Total evacuation of the pericardial contents, direct inspection and palpation of structures, correction of unsuspected pathology and simultaneous biopsy of the pericardium and other tissues can be achieved, while avoiding the need for repeated pericardiocentesis. The procedure can be done safely under local anesthesia, providing prompt relief of abnormal hemodynamics and a sample for tissue diagnosis.