Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion

Akyüz, Şükrü; Zengin, Ahmet; Aruğaslan, Emre; Yazıcı, Selçuk; Onuk, Tolga; Ceylan, Ufuk Sadık; Güngör, Barış; Gürkan, Ufuk; Öz, Tuğba Kemaloğlu; Kaşıkçıoğlu, Hülya; Çam, Neşe

doi:10.1007/s00059-014-4187-x

Cited by 26 publications

(13 citation statements)

References 21 publications

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“…(1,7) Consistent with other series, patients with malignant pericardial effusions have a poor prognosis with typical median survival of 3-7 months. (3)(4)(5)7) This is consistent with the 45.0% survival rate at 12 months in our patients. However, patients presenting with haemopericardium due to acute ascending aortic syndrome, which consists of aortic dissections or rupture of aortic aneurysms, and free wall myocardial rupture had the worst shortterm prognosis despite undergoing emergent surgery.…”

Section: Discussionsupporting

confidence: 92%

“…(2) Conversely, in advanced countries, complications of cardiac surgery and cancer are the most common causes. (3)(4)(5) Furthermore, the proportions of pericardial effusions caused by malignancy and postsurgical complications may be increasing over time, in part due to improved survival among cancer patients and the increasing number of cardiac interventions in developed countries. (6) The prognosis of pericardial effusion is essentially related to its aetiology.…”

Section: Discussionmentioning

confidence: 99%

“…Our major complication rate of 2.0% was consistent with other large series, confirming the relative safety of pericardiocentesis. (4,8) Given the low incidence of complications, it was not possible to discern whether the site of pericardial access or the additional use of fluoroscopy for guidance impacted complication rates. However, while complications are uncommon, three patients with incidental ventricular puncture required surgical repair in our series.…”

Section: Discussionmentioning

confidence: 99%

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Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

Cheong¹,

Law²,

Seow³

et al. 2020

smedj

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INTRODUCTION This study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia. METHODS Consecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system. RESULTS Of 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease. CONCLUSION Cancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

Cheong¹,

Law²,

Seow³

et al. 2020

smedj

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“…This may represent a racial disparity rather than a chance finding, and will need to be explored in the future studies . Also, the high risk of in‐hospital mortality in acute myocardial infarction with moderate or large pericardial effusion is well known, and is mostly attributed to cardiac rupture . Malignancy was another important predictor of inpatient mortality in ouranalysis.…”

Section: Discussionmentioning

confidence: 84%

Inpatient mortality and its predictors after pericardiocentesis: An analysis from the Nationwide Inpatient Sample 2009–2013

Sethi

Singbal

Kodumuri

et al. 2018

J Interven Cardiology

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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 trend = 0.001). Conclusion:The inpatient mortality after pericardiocentesis is high, particularly when associated with PCI and SHI. K E Y W O R D S iatrogenic effusion, inpatient mortality, pericardiocentesis 1 | BACKGROUND Pericardiocentesis, the percutaneous drainage of the pericardial sac, is a procedure performed in contemporary cardiovascular practice in both the elective and emergent setting. A timely pericardiocentesis can be lifesaving in tamponade; else, a pericardiocentesis is done for large effusions for diagnostic and therapeutic reasons. The current European Society of Cardiology guidelines gives pericardiocentesis a J Interv Cardiol. 2018;31:815-825.wileyonlinelibrary.com/journal/joic

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“…Vayre et al 8 chose the subxiphoid approach for most of his case series and reported a complication rate of 21% (0.9% major and 20.1% minor). Akyuz et al 9 reported the use of the subcostal (85%) and apical approach (15%) under echocardiographic guidance, and reported a complication rate of 1.3% for all minor and major complications.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided pericardiocentesis: a novel parasternal approach

Adi

Chuan

Rahman

et al. 2018

European Journal of Emergency Medicine

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Echo-guided pericardiocentesis in patients with clinically significant pericardial effusion

Abstract: Echo-guided pericardiocentesis has a high success and low complication rate in current practice. Among etiologies, malignancy remains the most common cause of clinically significant pericardial effusion and is associated with a poor prognosis.

Cited by 26 publications

References 21 publications

Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre

Inpatient mortality and its predictors after pericardiocentesis: An analysis from the Nationwide Inpatient Sample 2009–2013

Ultrasound-guided pericardiocentesis: a novel parasternal approach

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