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Ultrasound-guided pigtail catheter drainage of malignant pericardial effusions
1Department of Medicine, Royal Surrey County Hospital, Guildford.
Insights
Ultrasound-guided pericardiocentesis using pigtail catheters safely and effectively relieved cardiac tamponade in malignant pericardial effusions. This minimally invasive procedure offered palliation with minor complications and good patient survival.
Area of Science:
- Cardiology
- Interventional Radiology
- Oncology
Background:
- Malignant pericardial effusions frequently cause cardiac tamponade.
- Effective palliation of symptoms is crucial for improving quality of life in these patients.
Purpose of the Study:
- To evaluate the safety and efficacy of ultrasound-guided anterior pericardiocentesis with indwelling pigtail catheters for malignant pericardial effusions and cardiac tamponade.
Main Methods:
- Nine patients with malignant pericardial effusions and cardiac tamponade underwent anterior pericardiocentesis.
- Ultrasound guidance was used for catheter placement.
- Indwelling pigtail catheters were utilized for continuous drainage.
Main Results:
- All patients experienced symptom alleviation.
- No procedure-related deaths occurred.
- Minor complications included pleural effusions, atrial fibrillation, pericardial pain, and drainage issues. Recurrence was rare.
Conclusions:
- Ultrasound-guided pigtail catheter drainage is a safe, minimally invasive, and effective method for palliating cardiac tamponade in malignant pericardial disease.
- The procedure offers significant symptom relief and can be repeated if necessary.
Abstract:
Anterior pericardiocentesis was performed under ultrasound guidance using indwelling pigtail catheters in nine patients with malignant pericardial effusions and cardiac tamponade. Symptoms were alleviated in all cases and there were no deaths attributable to the procedure. Catheters remained in place for a median of 24 h (range 8-168 h). Complications were minor: asymptomatic left-sided or bilateral pleural effusions (n = 3), atrial fibrillation (n = 2), transient pericardial pain (n = 1) and erratic drainage (n = 1). Recurrence of the pericardial effusion was limited to a single case and occurred after 5 months of effective palliation. The procedure was successfully repeated with no further recurrence. One patient who went on to surgical fenestration 11 days after pericardiocentesis died 24 h post-operatively. The remaining patients died of the underlying malignant disease without further cardiac complication. Survival following the procedure ranged from 3 to 8 months. Ultrasound-guided pigtail catheter drainage is a minimally invasive, safe and effective method for the palliation of cardiac tamponade in patients with malignant pericardial disease.