Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsy - Results from a pilot study

From a registry of 136 patients undergoing pericardiocentesis, 14 patients with autoimmune and 15 patients with neoplastic effusions were selected. Al l underwent pericardioscopy, epicardial and pericardial biopsy with histolo gic, immunohistologic, and polymerase chain reaction/or in situ hybridizati on analysis for microbial DNAs and RNA. Pericardioscopy identified neoplast ic effusions by the high occurrence of protrusions. Fibrin threads and laye rs and neovascularization were found in both groups. For identification of the inflammatory and neoplastic process, the combined analysis of the cytol ogy of the effusion and epicardial biopsy evaluation proved to be most impo rtant. Epicardial biopsy demonstrated a slightly higher sensitivity for ide ntifying neoplastic disorders in the pericardium than cytology alone. Peric ardial biopsy was inconclusive. Intrapericardial administration of 1 g of c rystalloid triamcinolone in autoreactive pericarditis prevented recurrence in 13 of the 14 cases after 3 months and in 12 of the 14 cases after 1 year . In neoplastic effusion, intrapericardial administration of 50 mg cis-plat in for 24 h prevented recurrence of a hemodynamically relevant effusion aft er 3 months in all, and after 6-12 months in 14 of 15 patients. Mortality i n neoplastic effusion due to noncardiac tumor progression was 47 and 80%, r espectively, after 3 and 6 months, as can be expected in endstage neoplasti c disease. This study demonstrates that local drug application is feasible, life saving, and well tolerated by the patients. It opens perspectives for local drug application in other cardiac disorders as well.