Echocardiographically guided pericardiocentesis - The gold standard for the management of pericardial effusion and cardiac tamponade

BACKGROUND:The conventional surgical pericardiotomy and blind needle-punctu re pericardiocentesis using a subxiphoid approach have been reported to hav e only moderate success rates and to be associated with unacceptably high r ates of morbidity and mortality. More recently, echocardiographically guide d pericardiocentesis was reported to improve considerably the likelihood of success and the safety of this procedure. OBJECTIVE:To evaluate the efficacy and safety of echocardiographically guid ed pericardiocentesis in the authors' institution. PATIENTS AND METHODS:A s eries of consecutive patients who underwent percutaneous pericardiocentesis at the Hamilton General Hospital, Hamilton, Ontario, from June 1994 to Dec ember 1998. RESULTS: Forty-one patients underwent a total of 46 echocardiographically g uided pericardiocentesis procedures. The procedure was successful in 100% o f attempts. Clinical complications occurred in two (5%) patients: one patie nt with known coagulopathy developed hemothorax and on patient developed pu rulent pericarditis several days after the procedure. There were no deaths, and no patient required urgent referral for surgical management. CONCLUSIONS: Echocardiographically guided pericardiocentesis and effective, and is the methos of choice for therapeutic and diagnostic drainage of per icardial effusions. While echocardiographically guided pericardiocentesis w as described originally at centres with large volumes of patients with clin ically significant pericardial effusions and with extensive experience in u sing this technique, similar high success and low complication rates were a ttained at an institution with relatively low numbers of patients requiring pericardial drainage.