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Clinical Cardiology May 2022Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and...
BACKGROUND
Pericardiocentesis is an essential procedure for the diagnosis and treatment of pericardial effusions. The purpose of this study was to evaluate the feasibility and safety of a subxiphoid anterior approach using fluoroscopy aided by a sagittal axis chest computed tomography (CT) view in comparison with an ultrasound-guided apical approach in patients with chronic pericardial effusion.
METHODS
Among 72 consecutive patients (68.8 ± 14.4 years old, 52 males) with hemodynamically stable chronic pericardial effusions, a total of 85 procedures were retrospectively analyzed. We divided them into two groups according to the site of the approach for the pericardiocentesis.
RESULTS
A subxiphoid anterior approach (n = 53) was performed guided by fluoroscopy. The sagittal axis view of the chest CT was constructed to determine the puncture angle and direction for the subxiphoid anterior approach. An apical approach (n = 32) was performed by ultrasound guidance. The success rates of the anterior and apical approaches were 98.1% and 93.8%, respectively. There were two cases with cardiac perforations in the apical approach group, while no cases developed perforations in the subxiphoid anterior approach group.
CONCLUSION
The subxiphoid anterior approach for pericardiocentesis was feasible and safe for managing chronic pericardial effusions. A reconstruction of the sagittal axis view of the chest CT imaging was helpful to identify the direction and depth to access the pericardial space from the subxiphoid puncture site before the pericardiocentesis using the lateral fluoroscopic view.
Topics: Aged; Aged, 80 and over; Feasibility Studies; Female; Fluoroscopy; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Pericarditis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35266157
DOI: 10.1002/clc.23810 -
Journal of Family Medicine and Primary... Oct 2022The most common primary malignancies that affect the pericardium are lung cancers. Typically, pericardial involvement stays undiagnosed, with almost 1-20% of all...
The most common primary malignancies that affect the pericardium are lung cancers. Typically, pericardial involvement stays undiagnosed, with almost 1-20% of all tumor-related autopsies revealing invasion of the pericardium. Pericardial effusions are seldom the first location of metastasis and presentation of a primary malignancy. Malignant pericardial effusions are usually silent, although they cause dyspnea, chest discomfort, arrhythmias, cough, and, in rare cases, pericardial tamponade. In a patient with tamponade, a high index of tumor-related suspicion is crucial to rule out cancer. Emergency pericardiocentesis is indicated based on the clinical presentation, however, the patient frequently has a bad prognosis regardless of whether treatment is administered or not. In this case series, we report five cases of non-small cell lung cancer (NSCLC) with pericardial effusion as an initial presentation.
PubMed: 36618249
DOI: 10.4103/jfmpc.jfmpc_263_22 -
Texas Heart Institute Journal Aug 2018Proteasome inhibitors such as bortezomib and carfilzomib have been used effectively to treat patients who have certain hematologic malignancies. Proteasome activity is...
Proteasome inhibitors such as bortezomib and carfilzomib have been used effectively to treat patients who have certain hematologic malignancies. Proteasome activity is elevated in the heart, and potent inhibition results in accumulation of misfolded intracellular protein aggregates and apoptosis. Heart failure, conduction disturbances, and premature atherosclerosis have been associated with bortezomib therapy. We describe the case of a 49-year-old man who was taking bortezomib for graft-versus-host disease, when he developed cardiac tamponade and needed emergency pericardiocentesis. At that time, there was no evidence of graft-versus-host disease. To our knowledge, this is the first time that a pericardial effusion without underlying cardiac dysfunction has been reported in relation to bortezomib therapy. The diagnosis of pericardial effusion during bortezomib therapy, the absence of other causative agents-including graft-versus-host disease-and no recurrence of pericardial effusion after discontinuing bortezomib therapy suggest that bortezomib caused our patient's tamponade.
Topics: Antineoplastic Agents; Bortezomib; Cardiac Tamponade; Echocardiography, Doppler; Fluoroscopy; Follow-Up Studies; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Pericardiocentesis; Surgery, Computer-Assisted
PubMed: 30374242
DOI: 10.14503/THIJ-17-6242 -
Kardiochirurgia I Torakochirurgia... Mar 2021Pericardiocentesis is an invasive procedure performed to drain fluid from the pericardial cavity.
INTRODUCTION
Pericardiocentesis is an invasive procedure performed to drain fluid from the pericardial cavity.
AIM
We investigated the quality of videos about pericardiocentesis on YouTube and analysed their reliability and teaching properties, in the covid 19 period when online education has come to the fore.
MATERIAL AND METHODS
We searched YouTube using the terms "pericardiocentesis, cardiac tamponade, pericardial effusion, pericardial effusion drainage, pericardial tamponade" for uploaded videos. We scored every video according to the questions we prepared using the guidelines about pericardiocentesis. We used the HONcode score, GQS score, and RELIABILITY score to assess the quality of videos. Two physicians independently and blindly classified videos as useful or misleading and rated them.
RESULTS
A total of 168 videos were examined. After the application of exclusion criteria, 38 videos were evaluated. The pericardiocentesis checklist average score was 10.45 ±2.56. According to sources of videos, the average score for university or research hospital videos was 13.1 ±1.5, and videos whose source could not be identified had an average score of 7.5 ±2.0. According to the level of HONcode, 17 (44.7%) videos were low quality; according to GQS score, 8 (21.1%) videos were poor quality. The quality of university hospital uploads (β-coefficient 3.960, -value 0.004) were higher and statistically significant than other upload centres.
CONCLUSIONS
The educational value of pericardiocentesis videos on YouTube are low. It is recommended that doctors and patients be aware of and adopt the developing technology, and they should prefer videos uploaded from university hospitals and educational hospitals.
PubMed: 34552642
DOI: 10.5114/kitp.2021.105185 -
Brazilian Journal of Cardiovascular... Aug 2022There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is...
INTRODUCTION
There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade.
METHODS
We retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared.
RESULTS
Sixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044).
CONCLUSION
Apical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment.
Topics: Cardiac Surgical Procedures; Cardiac Tamponade; Humans; Pericardial Effusion; Pericardiocentesis; Retrospective Studies
PubMed: 35072404
DOI: 10.21470/1678-9741-2020-0714 -
The American Journal of Case Reports Jan 2023BACKGROUND Small pericardial effusions are common with chronic hypothyroidism, but large pericardial effusion with tamponade or pre-tamponade physiology is a rare...
BACKGROUND Small pericardial effusions are common with chronic hypothyroidism, but large pericardial effusion with tamponade or pre-tamponade physiology is a rare complication of severe uncontrolled hypothyroidism. Presentation of pericardial effusion of any etiology can range from being asymptomatic to hemodynamic instability with cardiac tamponade, depending on the amount and speed of accumulation of pericardial fluid, but pericardial effusion associated with hypothyroidism are usually small. Protracted medication non-adherence was a key factor in our patient's presentation. CASE REPORT We present a case of a woman in her 40s with a known history of autoimmune hypothyroidism with medication non-adherence for longer than 9 months who presented with fatigue, weight gain, limited physical activity, and exertional dyspnea with bilateral swelling of the upper and lower extremities. Examination revealed muffled heart sounds, positive JVD, and positive pulsus paradoxus. She had an elevated TSH, low free T4, and a high anti-thyroid peroxidase antibody level. Echocardiography revealed a large pericardial effusion with impending tamponade. Pericardiocentesis with pericardial drain was done and the patient's symptoms resolved quickly. The patient was restarted on a prior dose of levothyroxine 175 mcg. She had improved by the 3rd day of hospitalization; the pericardial drain was removed, and she was discharged with access to medication. Follow-up revealed complete resolution of her symptoms. CONCLUSIONS This case emphasizes the importance of recognition of hypothyroidism as the etiology of life-threatening large pericardial effusions, as it is treatable and recurrences are preventable. To prevent recurrence, it is important to achieve euthyroidism after treating an episode of pericardial effusion.
Topics: Adult; Female; Humans; Cardiac Tamponade; Hypothyroidism; Pericardial Effusion; Pericardiocentesis; Thyroxine; Echocardiography
PubMed: 36654486
DOI: 10.12659/AJCR.938520 -
Journal of Cardiology Cases Jul 2016A 57-year-old woman presented with a large idiopathic pericardial effusion with subsequent cardiac tamponade, in whom the intrapericardial pressure measured by...
A 57-year-old woman presented with a large idiopathic pericardial effusion with subsequent cardiac tamponade, in whom the intrapericardial pressure measured by pericardiocentesis was not elevated. The patient did not present with the classical clinical features of cardiac tamponade, requiring echocardiographic follow-up to make accurate diagnosis and treatment. This entity called low-pressure cardiac tamponade has been diagnosed anecdotally being an insidious condition that requires a high degree of suspicion. < Low-pressure cardiac tamponade is a clinical condition whose clinical diagnosis is highly difficult due to the dramatic loss of sensitivity of the classical clinical findings (dyspnea, tachycardia, hypotension, central venous pressure, and paradoxical pulse), making the diagnosis challenging. It requires a high index of suspicion at the echocardiographic study moment, and as in the classic cardiac tamponade many cases eventually require pericardiocentesis for confirmation and treatment.>.
PubMed: 30546648
DOI: 10.1016/j.jccase.2016.03.005 -
The Journal of Invasive Cardiology Nov 2020Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present...
Iatrogenic pneumopericardium after pericardiocentesis due to accidental leakage from the side port of the sheath has been reported in the literature. In the present case, it occurred during passage of the guidewire. Every step needs to be done meticulously. The patient should be advised not to take a deep breath during the puncture.
Topics: Humans; Iatrogenic Disease; Pericardiocentesis; Pneumopericardium
PubMed: 33130598
DOI: No ID Found -
Journal of Interventional Cardiology Dec 2018National registries have provided data on in-hospital outcomes for several cardiac procedures. The available data on in-hospital outcomes and its predictors after...
BACKGROUND
National registries have provided data on in-hospital outcomes for several cardiac procedures. The available data on in-hospital outcomes and its predictors after pericardiocentesis are mostly derived from single center studies. Furthermore, the outcomes after pericardiocentesis for iatrogenic pericardial effusion and the impact of procedural volume on in-hospital outcomes in the United States are largely unknown.
METHODS
We used national inpatient database files for the years 2009-2013 to estimate the inpatient outcomes after pericardiocentesis in all-comers and in the subgroups with iatrogenic effusion. We also studied the impact of hospital procedural volume, among other predictors, on inpatient mortality.
RESULTS
About 64,070 (95%CI 61 008-67 051) pericardiocentesis were performed in the United States during 2009-2013. Of these, 57.15% (56.02-58.26%) of the pericardiocentesis were in hemodynamically unstable patients. Percutaneous cardiac procedures were performed in 17.7% of patients (percutaneous coronary intervention (PCI) 4.02%, electrophysiologic procedures 13.58%, and structural heart intervention (SHI) 0.76%). Overall inpatient mortality was 12.30% (95%CI 11.66-12.96%). Inpatient mortality after PCI, electrophysiologic procedures, SHI and cardiac surgery were 27.67% (95%CI 24-31.67%), 7.8% (95%CI 6.67-9.31%), 22.36% (95%CI 15.06-31.85%) and 18.97% (95%CI 15.84-22.57%), respectively. There was an inverse association between hospital procedural volume and inpatient mortality, with a mortality of 14.01% (12.84-15.26%) at the lowest and 10.82% (9.44-12.37%) at highest quartile hospitals by procedure volume (p = 0.001).
CONCLUSION
The inpatient mortality after pericardiocentesis is high, particularly when associated with PCI and SHI.
Topics: Aged; Databases, Factual; Female; Hospital Mortality; Humans; Iatrogenic Disease; Inpatients; Male; Middle Aged; Percutaneous Coronary Intervention; Pericardial Effusion; Pericardiocentesis; Risk Factors; United States
PubMed: 30259579
DOI: 10.1111/joic.12563 -
The Journal of Innovations in Cardiac... Jun 2021Pericardial effusion is a rare but serious complication in cardiac electrophysiology procedures. To avoid progression to acute tamponade and reduce the risk of adverse...
Pericardial effusion is a rare but serious complication in cardiac electrophysiology procedures. To avoid progression to acute tamponade and reduce the risk of adverse patient outcomes, emergent pericardiocentesis is often necessary. The conduct of more pericardiocentesis training may further mitigate this risk. However, teaching and practice opportunities are rare, creating the need for pericardiocentesis simulators. While various pericardiocentesis simulators exist, their applications have been limited; further, commercial simulators are anatomically realistic but can be expensive. As such, cheaper homemade simulators have been developed, yet these may lack the cardiac anatomical features for a high-fidelity simulation or may be overly complex to assemble. The purpose of this study is to report initial findings from a pericardiocentesis simulator that incorporates a three-dimensional (3D) cardiac model that is economical, simple to assemble, and anatomically accurate. A 3D-printed cardiac model was printed from a computed tomography file. The model was fitted with a latex balloon-in-a-balloon pericardium filled with colored saline and placed in an ultrasound-compatible gelatin mold to create a pericardiocentesis simulator. The simulator was then tested with experienced and novice trainees at an academic hospital. A total of 10 participants (four interventional cardiology faculty members and six cardiology fellows) performed simulated pericardiocentesis using the simulator and completed a questionnaire to evaluate the model's features and usefulness. The overall feedback regarding this novel simulation approach was positive and the model exhibited important anatomical features to accurately simulate ultrasound-guided pericardiocentesis. All participants were able to successfully insert the needle into the pericardial space and all but one successfully placed the pericardial drain. Survey results indicated that the model was largely perceived as useful for training. This work suggests incorporating a 3D-printed cardiac model into a gelatin mold results in a simple and inexpensive yet high-fidelity pericardiocentesis simulation experience. This novel approach may be useful for teaching pericardiocentesis in an academic hospital.
PubMed: 34234989
DOI: 10.19102/icrm.2021.120603