RESCUE ECHOCARDIOGRAPHICALLY GUIDED PERICARDIOCENTESIS FOR CARDIAC PERFORATION COMPLICATING CATHETER-BASED PROCEDURES - THE MAYO-CLINIC EXPERIENCE

Objectives. The purpose of this study was to determine the safety and efficacy of rescue echocardiographically guided peri cardiocentesis as a primary strategy for the management of acute cardiac perforation an d tamponade complicating catheter-based procedures. Background. In thi s era of interventional catheterization, acute tamponade from cardiac perforation as a complication is encountered more frequently. The safe ty and efficacy of echocardiographically guided pericardiocentesis in this life-threatening situation and outcomes of patients managed by th is technique are unknown. Methods. Of the 960 consecutive echocardiogr aphically guided pericardiocenteses performed at the Mayo Clinic (1979 to 1997), 92 (9.6%) were undertaken in 88 patients with acute tampona de that developed in association with a diagnostic or interventional c atheter-based procedure. Most of the patients were hemodynamically uns table at the time of pericardiocentesis, with clinically overt tampona de in 40% and frank hemodynamic collapse (systolic blood pressure <60 mm Hg) in 57%. Clinical end points of interest were the success and co mplication rates of rescue pericardiocentesis and patient outcomes, in cluding the need for other interventions, clinical and echocardiograph ic follow-up findings and survival, Results. Rescue pericardiocentesis was successful in relieving tamponade in 91 cases (99%) and was the o nly and definitive therapy in 82% of the cases. Major complications (3 %) included pneumothorax (n = 1), right ventricular laceration (n = 1) and intercostal vessel injury with right ventricular laceration (n = 1); all were treated successfully. Minor complications (2%) included a small pneumothorax and an instance of transient nonsustained ventricu lar tachycardia; all were resolved spontaneously. Further surgical int ervention was performed in 16 patients (18%). No deaths resulted from the rescue pericardiocentesis procedure itself. Early death (<30 days) in this series was due to injuries from cardiac catheter based proced ures (n = 3), perioperative complications (n = 2) and underlying cardi ac diseases (n = 2), Clinical or echocardiographic follow-up for a min imum of 3 months or until death (if <3 months) for recurrent effusion or development of pericardial constriction was achieved in 87 (99%) of the patients. Conclusions. Echocardiographically guided pericardiocen tesis was safe and effective for rescuing patients from tamponade and reversing hemodynamic instability complicating invasive cardiac cathet er-based procedures. For most patients, this was the definitive and on ly therapy necessary. (C) 1998 by the American College of Cardiology.