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Heart Views : the Official Journal of... 2022Rheumatic heart disease and its impact on cardiac health is still a concern in developing countries. Percutaneous trans-mitral commissurotomy (PTMC) is the standard of...
BACKGROUND
Rheumatic heart disease and its impact on cardiac health is still a concern in developing countries. Percutaneous trans-mitral commissurotomy (PTMC) is the standard of care in managing severe rheumatic mitral stenosis (MS). This article reports a single-center, 10-year real-world experience in Qatar.
METHODS
In this retrospective study, we reviewed all the patients who underwent PTMC in Qatar between January 1, 2012, and January 1, 2022. Periprocedural data were collected at baseline, postprocedural, 1 year, and during the last follow-up. The primary outcome was procedural success (improvement in valve area by 50%, final valve area >1.5 cm, and freedom from > moderate mitral regurgitation, stroke, or pericardial effusion). Safety endpoints were freedom from death, periprocedural cardiogenic shock and cardiac arrest, stroke urgent mitral valve replacement (MVR), or pericardiocentesis. Long-term outcomes included the requirement of redo PTMC or MVR, in addition to rehospitalization due to arrhythmias, heart failure, or stroke.
RESULTS
Sixty-five patients were included in the review (age 42 ± 10, female 38 [58.5%]). Sixty-two patients (95.4%) had a successful procedure. One patient developed a hemorrhagic pericardial tamponade and cardiogenic shock, for which he underwent pericardiocentesis and emergency aortic root repair. One patient developed acute stroke 8 h after the procedure, and one patient had tamponade resolved with emergency pericardiocentesis. Two patients required MVR after 1 and 4 years, respectively.
CONCLUSION
PTMC is the mainstay of rheumatic MS management in patients with suitable anatomy as most patients have excellent outcomes with long-term freedom from surgery, which has been the case in our single-center experience.
PubMed: 36479163
DOI: 10.4103/heartviews.heartviews_78_22 -
Circulation Reports Apr 2023
PubMed: 37025941
DOI: 10.1253/circrep.CR-22-0061 -
Journal of the American College of... Sep 2020
Topics: Colchicine; Drainage; Humans; Neoplasm Recurrence, Local; Pericardial Effusion; Pericardiocentesis
PubMed: 32972533
DOI: 10.1016/j.jacc.2020.08.008 -
BMJ Case Reports Aug 2021A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and...
A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and discharged home. She represented 10 days later and was mottled and hypotensive with a high lactate, raised inflammatory markers, an acute kidney injury and bilateral loin pain. A CT of the thorax, abdomen and pelvis showed pleural effusions and a large pericardial effusion with features of cardiac tamponade on subsequent echocardiography. A pericardiocentesis was performed and she was admitted to intensive care for haemofiltration. Once the patient was stable, an inpatient cardiac MRI was requested to further investigate an enhancing pericardium and echo-bright areas in the inferior, inferoseptal and inferolateral walls of the left ventricle demonstrated on echocardiography. The cardiac MRI showed evidence of a recent infarction in the right coronary artery (RCA) territory with pericardial inflammation and a resolved pericardial effusion. Overall, the findings were in keeping with Dressler's syndrome.
Topics: Cardiac Tamponade; Echocardiography; Female; Humans; Middle Aged; Myocardial Infarction; Pericardial Effusion; Pericardiocentesis
PubMed: 34380681
DOI: 10.1136/bcr-2021-243577 -
Therapeutic Advances in Cardiovascular... Nov 2018Pericardial effusion (PE) can develop in several pathological scenarios, and is often initially evaluated by means of echocardiography. Computed tomography (CT) has been... (Review)
Review
BACKGROUND
Pericardial effusion (PE) can develop in several pathological scenarios, and is often initially evaluated by means of echocardiography. Computed tomography (CT) has been used as an aid in the management of patients presenting with PE, in selected cases. The role of CT-guided pericardiocentesis in contemporary practice, however, remains not fully ascertained. We aimed at presenting a systematic review concerning the state-of-the-art of this technique.
METHODS
A systematic review of published data on the use of CT for guiding pericardiocentesis was carried out (search performed on PubMed, ISI Web of Knowledge and Scopus databases).
RESULTS
From title and abstract analysis, 14 articles were included that met the prespecified criteria. After full-text analysis, six articles were excluded. The eight articles under analysis included a total of 635 procedures performed in 571 patients. CT guidance was mostly used in a postoperative setting (364 procedures). Most procedures were done mainly for therapeutic purposes (528 procedures). Success rates ranged from 94% to 100%. Complications ranged from 0% to 7.8%.
CONCLUSION
CT-guided pericardiocentesis is a useful technique in the approach to PE, in several clinical scenarios. Its use can be especially relevant in the postoperative period, as well as in individuals with suboptimal image quality (as assessed by echocardiography, for the moment the first choice in the approach to most cases of PE).
Topics: Aged; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Postoperative Complications; Predictive Value of Tests; Radiography, Interventional; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30111248
DOI: 10.1177/1753944718792413 -
CMAJ : Canadian Medical Association... Feb 2023
Topics: Humans; Pericardiocentesis; Pneumopericardium; Tomography, X-Ray Computed
PubMed: 36746478
DOI: 10.1503/cmaj.221137 -
Cancer Medicine Mar 2023Pericardiocentesis is undertaken in patients with cancer for diagnostic and therapeutic purposes. However, there are limited data on the frequency, characteristics and...
BACKGROUND
Pericardiocentesis is undertaken in patients with cancer for diagnostic and therapeutic purposes. However, there are limited data on the frequency, characteristics and mortality of patients with different cancers undergoing pericardiocentesis.
METHODS
All hospitalisations of adult cancer patients (≥18 years) in the US National Inpatient Sample between January 2004 and December 2017 were included. The cohort was stratified by discharge code of pericardiocentesis and cancer, using the International Classification of Diseases. The prevalence of pericardiocentesis, patient characteristics, cancer types and in-hospital all-cause mortality were analysed between cancer patients undergoing pericardiocentesis versus not.
RESULTS
A total of 19,773,597 weighted cancer discharges were analysed, out of which 18,847 (0.1%) underwent pericardiocentesis. The most common cancer types amongst the patients receiving pericardiocentesis were lung (51.3%), haematological (15.9%), breast (5.4%), mediastinum/heart (3.2%), gastroesophageal (2.2%) and female genital cancer (1.8%), whilst 'other' cancer types were present in 20.2% patients. Patients undergoing pericardiocentesis had significantly higher mortality (15.6% vs. 4.2%, p < 0.001) compared to their counterparts. The presence of metastatic disease (aOR 2.67 95% CI 1.79-3.97), weight loss (aOR 1.48 95% CI 1.33-1.65) and coagulopathy (aOR 3.22 95% CI 1.63-6.37) were each independently associated with higher mortality in patients who underwent pericardiocentesis.
CONCLUSION
Pericardiocentesis is an infrequent procedure in cancer patients and is most commonly performed in patients with lung, haematological and breast cancer. Cancer patients undergoing pericardiocentesis have increased mortality, irrespective of the underlying cancer type.
Topics: Adult; Humans; United States; Female; Pericardiocentesis; Prevalence; Hospital Mortality; Inpatients; Breast Neoplasms; Retrospective Studies
PubMed: 36266946
DOI: 10.1002/cam4.5373 -
Brazilian Journal of Cardiovascular... May 2023Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and...
Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and tamponading effusion. Surgical options include: pericardiocentesis, subxiphoid pericardiostomy, and pericardial window. The latter has proved to have lower incidence of recurrence; however, the technique has been continuously refined to improve the recurrence-free survival and decrease postoperative morbidity. We herein present a novel simple modification to minimize recurrence by anchoring the free edges of pericardial fenestration overlying the superior vena cava and right atrium to the chest wall. Follow-up showed no recurrence compared to 3.5% in the conventional procedure.
Topics: Humans; Vena Cava, Superior; Pericardial Effusion; Pericardial Window Techniques; Hemodynamics; Heart Atria
PubMed: 36459477
DOI: 10.21470/1678-9741-2022-0017 -
Korean Circulation Journal Jan 2022
PubMed: 34989195
DOI: 10.4070/kcj.2021.0382 -
European Journal of Emergency Medicine... Oct 2018The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency...
OBJECTIVE
The aim of this study was to evaluate a novel pericardiocentesis technique using an in-plane parasternal medial-to-lateral approach with the use of a high-frequency probe in patients with cardiac tamponade.
BACKGROUND
Echocardiography is pivotal in the diagnosis of pericardial effusion and tamponade physiology. Ultrasound guidance for pericardiocentesis is currently considered the standard of care. Several approaches have been described recently, which differ mainly on the site of puncture (subxiphoid, apical, or parasternal). Although they share the use of low-frequency probes, there is absence of complete control of needle trajectory and real-time needle visualization. An in-plane and real-time technique has only been described anecdotally.
METHODS AND RESULTS
A retrospective analysis of 11 patients (63% men, mean age: 37.7±21.2 years) presenting with cardiac tamponade admitted to the tertiary-care emergency department and treated with parasternal medial-to-lateral in-plane pericardiocentesis was carried out. The underlying causes of cardiac tamponade were different among the population. All the pericardiocentesis were successfully performed in the emergency department, without complications, relieving the hemodynamic instability. The mean time taken to perform the eight-step procedure was 309±76.4 s, with no procedure-related complications.
CONCLUSION
The parasternal medial-to-lateral in-plane pericardiocentesis is a new technique theoretically free of complications and it enables real-time monitoring of needle trajectory. For the first time, a pericardiocentesis approach with a medial-to-lateral needle trajectory and real-time, in-plane, needle visualization was performed in a tamponade patient population.
Topics: Adolescent; Adult; Cardiac Tamponade; Cohort Studies; Emergency Service, Hospital; Female; Humans; Image Enhancement; Malaysia; Male; Middle Aged; Patient Positioning; Patient Safety; Pericardiocentesis; Prognosis; Retrospective Studies; Sternum; Treatment Outcome; Ultrasonography, Doppler; Young Adult
PubMed: 28509710
DOI: 10.1097/MEJ.0000000000000471