How do the clinical findings in patients with pericardial effusions influence the success of aspiration?

Cooper, Jonathan; Oliver, R. M.; Currie, Philip J.; Walker, J. M.; Swanton, R. H.

doi:10.1136/hrt.73.4.351

Cited by 56 publications

(25 citation statements)

References 12 publications

(10 reference statements)

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“…The presence of eVusion loculation reduces the likelihood of successful pericardiocentesis. 38 This study is based on the experience of a single centre and several operators were involved in performing the percutaneous procedures, although all were performed or supervised by experienced operators. A further limitation is the relatively short follow up, to date, of some of the patients with tuberculous pericarditis, in view of the fact that long term complications-particularly constrictive pericarditis-may only become evident many years after the original infection.…”

Section: Discussionmentioning

confidence: 99%

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

et al. 2000

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The aim of the study was to determine the aetiology of large and symptomatic pericardial eVusions and to review the management and subsequent outcome. A survey was done on a consecutive cases of patients who had undergone percutaneous pericardiocentesis over a 10 year period in a city centre general hospital serving a multiethnic catchment population. In all, 46 patients (24 male, 22 female; age range 16 to 90 years, mean 54 years) underwent a total of 51 pericardial drainage procedures (or attempted pericardiocentesis) between 1989 and 1998. Malignancy (44%), tuberculosis (26%), idiopathic (11%), and post-cardiac surgery (9%) were the most common causes of pericardial eVusion. The most common presenting symptoms were breathlessness (90%), chest pain (74%), cough (70%), abdominal pain (61%) (presumed to be related to hepatic congestion), and unexplained fever (28%). In the 12 cases of tuberculous pericarditis, nine occurred in patients of Indo-Asian origin, and three in patients of AfroCaribbean origin. Fever, night sweats, and weight loss were common among these patients, occurring in over 80% of cases of tuberculous pericarditis. Pulsus paradoxus was the most specific sign (100%) for the presence of echocardiographic features of tamponade, with strongest positive predictive value (100%). Although malignancy remains the most common cause in developed countries, tuberculous disease should be considered in patients from areas where tuberculosis is endemic. Percutaneous pericardiocentesis remains an eVective measure for the immediate relief of symptoms in patients with cardiac tamponade, although its diagnostic yield in tuberculous pericarditis is relatively low. (Postgrad Med J 2000;76:809-813)

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Section: Discussionmentioning

confidence: 99%

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

et al. 2000

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“…Clearly, making an early diagnosis and having an experienced interventional cardiologist perform emergency pericardiocentesis are life-saving measures in cases of tamponade [4,5]. The present report describes an emergency response to a nearly catastrophic complication of PLAAC, wherein pericardial tamponade was reversed by aspiration of the pericardial hemorrhage, followed by immediate reinfusion of that blood.…”

Section: Discussionmentioning

confidence: 89%

Emergency Autotransfusion for Managing Iatrogenic Hemorrhagic Pericardial Effusion

2017

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Iatrogenic hemorrhagic pericardial effusion (IHPE) is one of the major complications encountered in daily percutaneous intracardiac interventions. A 79-year-old man was scheduled for percutaneous left atrial appendage closure (PLAAC) at our department. He had nonvalvular atrial fibrillation, with a contraindication to oral anticoagulants because of a history of recurrent significant intestinal bleeding with angiodysplasia. During the deployment of the PLAAC device (Watchman device), patient became hemodynamically unstable with a typical decrease in the systolic arterial pressure of more than 10 mm Hg during inspiration (pulsus paradoxus) because pericardial tamponade occurred due to perforation of the left atrial appendage. We report our successful experience with management of IHPE by immediate pericardiocentesis, insertion of percutaneous catheter drainage (PCD), and retransfusing drained pericardial blood through a central venous line. IHPE is not uncommon complication in daily percutaneous intracardiac interventions. Pulsus paradoxus is the most important clinical sign of cardiac tamponade. Our approach by immediately retransfusing drained pericardial blood through a central venous line allowed rapid physiologically appropriate recovery. Future consensus of opinion of experts focusing on autotransfusion in such cases is needed.

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“…This was confirmed by Krikorian and Hancock's study of 123 patients [33]: The procedure was successful in 93% of cases if the effusion was large and of both anterior and posterior location, whereas the rate of success was only 58% with small and posteriorly located effusions. Analyzing the predictors of failure in echocardiography-guided pericardiocentesis Cooper et al [56] observed that the only parameter associated with unsuccessful aspiration was loculation of pericardial effusion, particularly after cardiac surgery. However, in a recent large series of patients from the Mayo Clinic pericardiocentesis of loculated pericardial effusion after cardiac surgery, reached with echocardiographic guidance an efficacy of 96% with only 2% of major complications [49].…”

Section: Feasibility Of Fluoroscopy-guided Pericardiocentesismentioning

confidence: 99%

Pericardial Access and Drainage: Standard Techniques

Maisch

Ristić²,

Seferović³

et al. 2011

Interventional Pericardiology

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How do the clinical findings in patients with pericardial effusions influence the success of aspiration?

Cited by 56 publications

References 12 publications

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population

Emergency Autotransfusion for Managing Iatrogenic Hemorrhagic Pericardial Effusion

Pericardial Access and Drainage: Standard Techniques

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