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PERICARDIOCENTESIS GUIDED BY ECHOCARDIOGRAPHY

R. Kočková, W. El-Husseini, A. Pravečková, P. Frídl, T. Marek, J. Kautzner (Praha)

Tématický okruh: Akutní stavy v kardiologii, Akutní koronární syndromy

Typ: Ústní sdělení - lékařské, XXII. výroční sjezd ČKS

Introduction

We evaluated our single centre prospective registry of pericardiocenteses performed in Non-Invasive Cardiology Department under echocardiography guidance without fluoroscopy.

Methods and patients

All pericardiocenteses performed in Non-Invasive Cardiology Department were prospectively recorded and we report our results for the period from 1998 till 2012. We focused on the procedural safety and concordance between echocardiographic and clinical signs of tamponade. All the procedures were performed by experienced cardiologist under strictly sterile condition with CPR equipment on site. Procedural complications were evaluated till hospital discharge.

Results

During 14-year period, 253 pericardiocenteses were performed in 185 patients (0.8% of all pericardial effusions). The aetiology of pericardial effusion was the heart transplantation in 44 (24%), postpericardiotomy syndrome in 22 (12%), infective pericarditis in 33 (18%), malignancy in 23 (12%), invasive procedure 19 (10%), idiopathic in 33 (18%). The most frequently used entry was the apical approach in 236 cases (93%), than the parasternal in 9 (4%) and the subxiphoideal 8 (4%) approaches in minority of cases. The rate of complications was only 7 (3%) of which all were treated medically with no surgical intervention required and with no patients death. There was a significant correlation between echocardiography of tamponade and clinical assessment.

Conclusion

Echocardiography guided pericardiocentesis performed by an experienced Cardiologist is safe with high rate of success and rare complications. Apical entry is safe and dominant approach for pericardiocentesis under echocardiographic navigation.