Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade

Abstract

We performed percutaneous balloon pericardial window (PBPW) in 8 patients (age 40 to 70 yrs; 4 men, 4 women) with malignant pericardial effusion and tamponade. Pericardial window was indicated because they continued to drain greater than 100 ml/day of pericardial fluid through the pigtail catheter for greater than or equal to 3 days. A 0.038 inch guidewire was advanced through the pigtail catheter into the pericardial space and then the catheter was removed. A 20 mm diameter, 3 cm long balloon dilating catheter was advanced to straddle the parietal pericardium. Manual inflations were performed until the waist produced by the pericardium disappeared. All patients tolerated the procedure well with minimal discomfort and with no complications. A left or bilateral pleural effusion occurred in all patients after PBPW. No patient developed recurrent pericardial tamponade at a mean follow-up of 6 +/- 2 months. Thus, PBPW is a useful and safe technique to avoid surgery in patients with malignant pericardial effusion and tamponade.

CT Findings in Patients With Pericardial Effusion: Differentiation of Malignant and Benign Disease

“…Furthermore, coexistence of irregular pericardial thickening and mediastinal lymph node enlargement may strongly suggest the presence of malignant pericardial effusion; therefore, therapeutic intervention, such as use of a percutaneous technique for window formation in the pericardium, is necessary at the time of initial pericardiocentesis [30][31][32].…”

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

“…In cancerous patients with symptomatic large PE, the standard treatment consisted of pericardiocentesis and drainage. Palacios et al reported on the effectiveness of PBP, 1 and in a multicentre study of 50 patients by Ziskind et al the success rate of PBP was 95%. 2 The recurrence rate after pericardiocentesis may be as high as 62%.…”

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“…This maybe initially treated by subxiphoid pericardiocentesis under echocardiographic guidance [8]. If fluid re-accumulates, then a more permanent solution may be the creation of a pericardial window to drain any future fluid build-up into the pleural space (by balloon echoguided percutaneous balloon, or through minithoracotomy or videoassisted thoracoscopic procedures) [9,10]. An alternative is subxiphoid pericardiotomy and pericardial-peritoneal window.…”

“…Treatment options include NSAIDs initially, colchicine for recurrences, and steroids, azathioprine and cyclophosphamide as a last resort [4,28]. Development of chronic, symptomatic, large pericardial effusions require percutaneous catheter based methods [9] J Integr Cardiol, 2015, doi: 10.15761/JIC.1000105 Volume 1(1): [12][13][14][15][16][17] or creation of a pericardial window either into the abdominal or pleural cavities for drainage [10,29].…”

“…Subxiphoid pericardiostomy and drainage is a safe procedure that provides effective and durable symptomatic relief [39]. These effusions maybe amenable to percutaneous balloon pericardial window into the pleural space to alleviate the tamponade [9]. Thoracoscopic pericardiectomy may also be performed effectively and safely in these patients, with better visualization and resection of the pericardium than percutaneous or subxiphoid techniques, and less wound related pain than an open thoracotomy [10].…”