New directions in diagnosis and treatment of pericardial disease - A project of the Taskforce on Pericardial Disease of the Worlds Heart Federation

New directions in the diagnosis and treatment of pericardial diseases synth esize the achievements of modern imaging with molecular biology and immunol ogy techniques. Comprehensive and systematic implementation of new techniqu es of pericardiocentesis, pericardial fluid analysis, pericardioscopy, epic ardial and pericardial biopsy, as well the application of comprehensive mol ecular biology and immunology techniques for pericardial fluid and biopsy a nalyses have opened new windows to the pericardial diseases, permitting ear ly specific diagnosis and creating foundations for etiologic treatment in m any cases. In patients with recurrent pericarditis, resistant to conventional treatmen ts, as well as in patients with neoplastic pericarditis an alternative intr apericardial treatment regimen was suggested by the Taskforce on Pericardia l Diseases of the World Heart Federation. Intrapericardial application of m edication avoids systemic side effects with increased local efficacy. The f ollowing protocols are proposed: CIRP (colchicine in recurrent pericarditis ) - colchicine vs placebo in chronic/recurring pericarditis without pericar diocentesis; TRIPE (triamcinolone in pericardial effusion) - intrapericardi al instillation of triamcinolone + 6 months colchicine vs pericardial punct ure without instillation + 6 months colchicine; NEPIN (neoplastic effusion and pericardial instillation) - pericardiocentesis and drainage + intraperi cardial instillation of cisplatin or thiotepa.