P1005Safety and efficacy of echocardiography-guided pericardiocentesis under continuous visualization

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Purpose: Echocardiography-guided pericardiocentesis is widely used in Coronary Care Units. We assessed safety, efficacy and feasibility of echocardiography-guided pericardiocentesis under continuous visualization.Methods: 97 pericardiocentesis on 97 patients (mean age 60 years old, range 18-92) were performed from 1993 to 2010 at our CCU. This procedure was carried out for cardiac tamponade in 92 cases and for diagnosis in 5 cases.Percutaneous puncture (anterior thoracic in 74 cases, subxiphoid in 23 cases) was performed at the site closest to the exploring probe, where the largest amount of fluid was detected.A needle carrier supported by a bracket with fixed angulation was mounted on the probe. The needle guide kit was then mounted on the sterile sheathed probe. The needle was advanced through the tissues and inside the pericardial space under continuous visualization. When the pericardial effusion was reached and the placement of the needle inside the pericardial space was echographically confirmed, a drainage catheter was introduced along the guide-wire, according to the Seldinger's technique.Results: The procedure was successful in 96 out of 97 cases. Drained fluid ranged from 20 to 2000 ml. In 1 case of diagnostic pericardiocentesis the pericardial space was impossible to reach due to minimal amount of pericardial fluid. In 1 case of acute tamponade following transcatheter ablation of AV node, the pericardial puncture caused a pleural-pericardial shunt with consequent drainage of pericardial fluid into the pleural space and symptom resolution. In 1 case a transient AV type III block occurred. Two patients had a vasovagal reaction without syncope. One patient on anticoagulants for recent aortic and mitral valve replacement developed mediastinal haematoma that required surgical drainage two weeks later. Puncture of cardiac chambers did not occur, and emergency surgical drainage was not required in any case.Conclusions: only one major complication occurred using this procedure. The incidence of "minor" sequelae (e.g. right ventricle puncture) was lower than the incidence reported by other studies on pericardiocentesis without continuous visualization. Our technique appears to be safe and easy to perform even in the presence of minimal amounts of pericardial fluid.

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