Primary percutaneous balloon pericardiotomy for malignant pericardial effusion

Abstract

Balloon pericardiotomy, as initial management of symptomatic malignant pericardial effusions, allows a definitive procedure to be performed at presentation. This can be achieved with low complication rates, similar to treatment by simple drainage.

Controversial Issues in the Management of Pericardial Diseases

“…70 Less invasive options for recurrent symptomatic effusions are derived mainly from experience in the management of neoplastic pericardial effusions and include prolonged catheter drainage and the creation of the so-called "pericardial window." [71][72][73][74][75][76] In patients with cardiac tamponade or significant effusion, initial relief can easily be obtained with percutaneous pericardiocentesis followed sometimes by drainage with an indwelling catheter. Prolonged catheter drainage is an effective means of preventing fluid reaccumulation, although the mechanism by which this occurs is probably related more to the obliteration of the pericardial space after inflammation provoked by the catheter than to fluid drainage itself.…”

“…Reported complications include fever (up to 28%), pneumothorax or need for a chest tube (up to 20%), and rarely bleeding from a pericardial blood vessel. 75,76 Key points: (1) Pericardiectomy is recommended for persistent constrictive pericarditis; (2) patients with newly diagnosed constrictive pericarditis who are hemodynamically stable may be given a trial of conservative management (antiinflammatory therapy with NSAIDs and/or corticosteroids) for 2 to 3 months before pericardiectomy is recommended; and (3) pericardiectomy is almost never indicated for recurrent pericarditis except for patients with repeated recurrences with cardiac tamponade and those with evidence of serious steroid toxicity, although other approaches may be equally effective and less invasive (eg, pericardial window by either conventional heart surgery or video-assisted thoracoscopy).…”

Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion

“…More recently Swanson et al showed that balloon pericardiotomy as the initial management of symptomatic malignant PEs, allows a definitive procedure to be performed at presentation and that reaccumulation rates between balloon pericardiotomy and simple aspiration (7.4% vs 14.3%) and complication rates (7.4% vs 7.1%) were not statistically different. 4 Therefore, primary therapy with a pericardial window creation should be considered.…”

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

“…Complications were fever (30%) and pneumothorax (20%). More recently, the outcome of 43 patients, with various cancers, treated with primary single balloon pericardiostomy has been reported [80] . In this report, pain was a common side effect and required opioids before and during the procedure; 7.4% of patients had reaccumulation of fluid requiring reintervention, and the median survival was only 56 d. The authors suggested this technique as the management of choice for malignant pericardial effusion, but an editorial comment suggested to consider this approach as a second choice after percutaneous catheter pericardial drainage [81] .…”