EVALUATION OF ECHO-GUIDED PERICARDIOCENTE SIS FOR TAMPONADE

Between April 1982 and December 1995, 78 consecutive patients with an average age of 57 +/- 13 years underwent echo-guided pericardiocentesi s in the intensive care unit for poorly tolerated pericardial effusion s. The patients were admitted to the cardiology departments of Ambrois e-Pare Hospital at Boulogne (n = 44), Gilles-de-Corbeil Hospital at Co rbeil-Essonnes (n = 31) and Val-de-Grace Hospital in Paris (n = 3). Th e underlying aetiologies were malignant disease (n = 31), idiopathic ( n = 13), post-surgery (n = 7), infection (n = 7), autoimmune (n = 6), post-radiotherapy (n = 6), post-myocardial infarction (n = 3), chronic renal failure (n = 3) and coagulation defects (n = 2). Pericardial pu ncture was undertaken by the subxiphoid (n = 77) or left parasternal ( n = 1) approaches under guidance of echocardiography. Intra-pericardia l contrast was used to verify the position of the catheter. The averag e volume of liquid drained was 580 +/- 390 mt. After pericardiocentesi s, continuous drainage was continued in 17 patients for an average dur ation of 63 +/- 29 hours. The total average volume was 750 +/- 330 mL. The major complications were a) three deaths during the puncture, not caused by the procedure after post-mortem study, b) ten right ventric ular punctures with no consequences in 9 cases, c) two cases of shock, one of which was due to a pre-existing septicaemia of pulmonary origi n, d) two non-sustained Ventricular arrhythmias. The minor incidents w ere six vasovagal syndromes during the procedure and four paroxysmal s upraventricular arrhythmias. Emergency surgical drainage was required (n = 3) for a failed procedure and late surgical drainage (n = 12) for persistence or recurrence of the effusion. No surgical drainage was r equired in the 17 patients placed under continuous aspiration. Echo-gu ided pericardiocentesis is a simple procedure and provides rapid haemo dynamic relief in subjects generally in serious condition. Continuous aspiration may help avoid the need for surgical drainage for persisten ce or recurrence of the effusion.