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Journal of Cardiovascular... Nov 2023Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the... (Review)
Review
Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the complexity of the 3-dimensional arrhythmogenic substrate due to advances in imaging and mapping technologies there has been an expansion of epicardial procedures in recent years. Equally, minimally invasive implantation of epicardial pacing, cardiac resynchronization, or defibrillation leads is expanding in specific patients where transvenous systems are contraindicated or their long term sequelae should be ideally avoided. Selective delivery of intrapericardial pharmacological antiarrhythmic therapy is yet another potential indication, albeit still investigational. The expanding indications for percutaneous epicardial procedures is contrasted by the still substantial risk and challenges associated with accessing the pericardial space. Myocardial perforation, coronary artery laceration, and damage to the surrounding organs are all recognized and feared complications. A number of innovative epicardial access techniques have been proposed to overcome the difficulties and risks of traditional dry subxiphoid punctures and may allow for more widespread use of epicardial access in the future. We review 10 different established and novel subxiphoidal epicardial access techniques describing procedural success rates, safety profile and overall experience. The technical aspects as well as access times and costs for extra equipment will be reviewed. Finally, an outlook of reported preclinical techniques awaiting in-human feasibility studies is provided.
Topics: Humans; Pericardium; Arrhythmias, Cardiac; Cardiac Electrophysiology; Catheter Ablation
PubMed: 37735956
DOI: 10.1111/jce.16069 -
Heart Rhythm Jul 2023
Topics: Humans; Epicardial Mapping; Pericardial Window Techniques; Electrocardiography; Tachycardia, Ventricular; Catheter Ablation; Pericardium
PubMed: 37088232
DOI: 10.1016/j.hrthm.2023.04.015 -
Medicine Aug 2023Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic...
RATIONALE
Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam.
PATIENT CONCERNS
An 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion.
DIAGNOSES
The patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis.
INTERVENTIONS
Decompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia.
OUTCOMES
Severe hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours).
LESSONS
Remimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.
Topics: Male; Humans; Aged, 80 and over; Cardiac Tamponade; Pericardial Effusion; Hemothorax; Benzodiazepines
PubMed: 37565852
DOI: 10.1097/MD.0000000000034822 -
European Heart Journal. Case Reports Jul 2023Pericardial decompression syndrome (PDS) is an uncommon complication of pericardial drainage of large pericardial effusions and cardiac tamponade characterized by...
BACKGROUND
Pericardial decompression syndrome (PDS) is an uncommon complication of pericardial drainage of large pericardial effusions and cardiac tamponade characterized by paradoxical haemodynamic instability following drainage. Pericardial decompression syndrome may occur immediately, or in the days following pericardial decompression, and presents with signs and symptoms suggestive of uni-/biventricular failure or acute pulmonary oedema.
CASE SUMMARY
This series describes two cases of this syndrome which demonstrates acute right ventricular failure as a mechanism of PDS and provides insights into the echocardiographic findings and clinical course of this poorly understood syndrome. Case 1 describes a patient who underwent pericardiocentesis, whilst Case 2 describes a patient who underwent surgical pericardiostomy. In both patients, acute right ventricular failure was observed following the release of tamponade and is favoured to be the cause of haemodynamic instability.
DISCUSSION
Pericardial decompression syndrome is a poorly understood, likely underreported complication of pericardial drainage for cardiac tamponade associated with high morbidity and mortality. Whilst a number of hypotheses exist as to the aetiology of PDS, this case series supports haemodynamic compromise being secondary to left ventricular compression following acute right ventricular dilatation.
PubMed: 37408529
DOI: 10.1093/ehjcr/ytad275 -
Frontiers in Cardiovascular Medicine 2023The aim of this study was to develop a deep-learning pipeline for the measurement of pericardial effusion (PE) based on raw echocardiography clips, as current methods...
OBJECTIVES
The aim of this study was to develop a deep-learning pipeline for the measurement of pericardial effusion (PE) based on raw echocardiography clips, as current methods for PE measurement can be operator-dependent and present challenges in certain situations.
METHODS
The proposed pipeline consisted of three distinct steps: moving window view selection (MWVS), automated segmentation, and width calculation from a segmented mask. The MWVS model utilized the ResNet architecture to classify each frame of the extracted raw echocardiography files into selected view types. The automated segmentation step then generated a mask for the PE area from the extracted echocardiography clip, and a computer vision technique was used to calculate the largest width of the PE from the segmented mask. The pipeline was applied to a total of 995 echocardiographic examinations.
RESULTS
The proposed deep-learning pipeline exhibited high performance, as evidenced by intraclass correlation coefficient (ICC) values of 0.867 for internal validation and 0.801 for external validation. The pipeline demonstrated a high level of accuracy in detecting PE, with an area under the receiving operating characteristic curve (AUC) of 0.926 (95% CI: 0.902-0.951) for internal validation and 0.842 (95% CI: 0.794-0.889) for external validation.
CONCLUSION
The machine-learning pipeline developed in this study can automatically calculate the width of PE from raw ultrasound clips. The novel concepts of moving window view selection for image quality control and computer vision techniques for maximal PE width calculation seem useful in the field of ultrasound. This pipeline could potentially provide a standardized and objective approach to the measurement of PE, reducing operator-dependency and improving accuracy.
PubMed: 37600054
DOI: 10.3389/fcvm.2023.1195235 -
Journal of Zoo and Wildlife Medicine :... Jul 2023The first objective of this study was to establish clinically relevant techniques for cardiac echocardiography in nonanesthetized Galapagos ( complex) and Aldabra ()...
The first objective of this study was to establish clinically relevant techniques for cardiac echocardiography in nonanesthetized Galapagos ( complex) and Aldabra () tortoises. A second objective was to establish guidelines for determining normal echocardiographic anatomy and function in both species. Select echocardiographic reference values were defined for 17 healthy Galapagos tortoises and 27 healthy Aldabra tortoises. Tortoises were either placed in ventral recumbency on an elevated surface or allowed to stand in a natural position by using food distraction. An ultrasound probe was applied in the left or right cervicobrachial window and was positioned in two long axis views to evaluate the three chambers of the heart and the associated great vessels, the presence of pericardial effusion, the atrioventricular inflow velocities, and pulmonic and aortic outflow velocities. The heart rate was 28 ± 12 (median ± SD) bpm, and the ejection fraction was 60.5 ± 10%. Thirty-four of 44 tortoises had identifiable physiologic pericardial effusion. All tortoises were successfully imaged using the techniques described, with consistent identification of cardiac structure and assessment of function. This study provides echocardiographic reference intervals for the clinical evaluation of suspected cardiac disease in captive-managed Galapagos and Aldabra tortoises.
Topics: Animals; Turtles; Pericardial Effusion; Echocardiography; Ultrasonography
PubMed: 37428693
DOI: 10.1638/2020-0125 -
Cardiology in the Young Apr 2024Pericardial tamponade, which increases postoperative mortality and morbidity, is still not uncommon after paediatric cardiac surgery. We considered that posterior...
OBJECTIVE
Pericardial tamponade, which increases postoperative mortality and morbidity, is still not uncommon after paediatric cardiac surgery. We considered that posterior pericardiotomy may be a useful and safe technique in order to reduce the incidence of early and late pericardial tamponade. Herein, we present our experience with creation of posterior pericardial window following congenital cardiac surgical procedures.
METHODS
This retrospective study evaluated 229 patients who underwent paediatric cardiac surgical procedures between June 2021 and January 2023. A posterior pericardial window was created in all of the patients. In neonates and infants, pericardial window was performed at a size of 2x2 cm, whereas a 3x3 cm connection was established in elder children and young adults. A curved chest tube was placed and positioned at the posterolateral pericardiophrenic sinus. An additional straight anterior mediastinal chest tube was also inserted in every patient. Transthoracic echocardiographic evaluations were performed daily to assess postoperative pericardial effusion.
RESULTS
A total of 229 (135 male, 94 female) patients were operated. Mean age and body weight were 24.2 ± 26.7 months and 10.2 ± 6.7 kg, respectively. Eight (3.5%) of the patients were neonates where 109 (47.6%) were infants and 112 (48.9%) were in childhood. Fifty-two (22.7%) re-do operations were performed. Six (2.6%) patients underwent postoperative surgical re-exploration due to surgical site bleeding. Any early or late pericardial tamponade was not encountered in the study group.
CONCLUSIONS
Posterior pericardial window is an effective and safe technique in order to prevent both the early and late pericardial tamponade after congenital cardiac surgery.
Topics: Infant, Newborn; Humans; Male; Female; Child; Cardiac Tamponade; Retrospective Studies; Pericardial Effusion; Treatment Outcome; Cardiac Surgical Procedures
PubMed: 37822207
DOI: 10.1017/S1047951123003426 -
Journal of Chest Surgery Mar 2024Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical...
BACKGROUND
Pericardial effusion (PE) is a serious condition in cancer patients, primarily arising from malignant dissemination. Pericardial window formation is a surgical intervention for refractory PE. However, the long-term outcomes and factors associated with postoperative survival remain unclear.
METHODS
We retrospectively analyzed data from 166 oncology patients who underwent pericardial window formation at Samsung Medical Center between 2011 and 2023. We analyzed survival and PE recurrence regarding surgical approach, cancer type, and cytopathological findings. To identify factors associated with survival, we utilized Cox proportional-hazards regression.
RESULTS
All patients had tumors documented in accordance with the American Joint Committee on Cancer staging manual, including lung (61.4%), breast (9.6%), gastrointestinal (9.0%), hematologic (3.6%), and other cancers (16.4%). Surgical approaches included mini-thoracotomy (67.5%) and thoracoscopy (32.5%). Postsurgical cytopathology confirmed malignancy in 94 cases (56.6%). Over a median follow-up duration of 50.0 months, 142 deaths and 16 PE recurrences occurred. The 1-year overall and PE recurrence-free survival rates were 31.4% and 28.6%, respectively. One-year survival rates were significantly higher for thoracoscopy recipients (43.7% vs. 25.6%, p=0.031) and patients with negative cytopathology results (45.1% vs. 20.6%, p<0.001). No significant survival difference was observed between lung cancer and other types (p=0.129). Multivariate analysis identified New York Heart Association class, cancer stage, and cytopathology as independent prognostic factors.
CONCLUSION
This series is the largest to date concerning window formation among cancer patients with PE. Patients' long-term survival after surgery was generally unfavorable. However, cases with negative cytopathology or earlier tumor stage demonstrated comparatively high survival rates.
PubMed: 38228497
DOI: 10.5090/jcs.23.113 -
Heart (British Cardiac Society) May 2024Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who... (Comparative Study)
Comparative Study
OBJECTIVES
Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who underwent pericardiocentesis versus pericardial window formation.
METHODS
In the present study, 765 consecutive patients with cancer (mean age 58.4 years, 395 men) who underwent pericardial drainage between 2003 and 2022 were retrospectively analysed. All-cause death and MPE recurrence were compared based on the drainage method (pericardiocentesis vs pericardial window formation) and time period (period 1: 2003-2012; period 2: 2013-2022).
RESULTS
Pericardiocentesis was performed in 639 (83.5%) patients and pericardial window formation in 126 (16.5%). There was no difference in age, sex distribution, proportion of metastatic or relapsed cancer, and chemotherapy status between the pericardiocentesis and pericardial window formation groups. Difference was not found in all-cause death between the two groups (log-rank p=0.226) regardless of the period. The pericardial window formation group was associated with lower MPE recurrence than the pericardiocentesis group (6.3% vs 18.0%, log-rank p=0.001). This advantage of pericardial window formation was more significant in period 2 (18.1% 1.3%, log-rank p=0.005). In multivariate analysis, pericardial window formation was associated with lower MPE recurrence (HR: 0.31, 95% CI: 0.15 to 0.63, p=0.001); younger age, metastatic or relapsed cancer, and positive malignant cells in pericardial fluid were associated with increased recurrence.
CONCLUSION
In patients undergoing pericardial drainage for MPE, pericardial window formation showed mortality outcomes comparable with pericardiocentesis and was associated with lower incidence of MPE recurrence.
Topics: Humans; Pericardiocentesis; Male; Female; Middle Aged; Retrospective Studies; Pericardial Effusion; Neoplasms; Aged; Treatment Outcome; Pericardial Window Techniques; Recurrence; Drainage; Time Factors; Risk Factors
PubMed: 38302262
DOI: 10.1136/heartjnl-2023-323542 -
Cureus Nov 2023Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect various organs and systems in the body, leading to a wide range of clinical...
Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect various organs and systems in the body, leading to a wide range of clinical manifestations. Pericardial effusion, which is an accumulation of excessive fluid in the pericardial sac surrounding the heart, can be one of the early presentations of SLE in some individuals. When it occurs in young females, it can be particularly concerning, as SLE predominantly affects women of childbearing age. In this case report, we describe pericardial effusion as the initial presentation of SLE in a 37-year-old mother of four children. Importantly, early diagnosis and consistent follow-up are critical for improving the prognosis and quality of life for individuals with SLE.
PubMed: 38125254
DOI: 10.7759/cureus.49080