Intrapericardial treatment of autoreactive myocarditis with triamcinolon -Successful administration in patients with minimal pericardial effusion

A major clinical drawback in the treatment of autoreactive pericarditis is its inherent feature to relapse. Intrapericardial treatment with triamcinol one was reported to be efficient in patients with large, symptomatic autore active pericardial effusions, avoiding side effects of systemic treatment a s well as compliance problems. Intrapericardial treatment with 300 mg/m(2) triamcinolone was for the first time performed in patients with autoreactive myopericarditis and minimal p ericardial effusions (75 to 110 mi). After 12 months of follow-up both pati ents are asymptomatic and there were no further recurrences of pericardial effusion. Pericardiocentesis in these patients was performed with the appli cation of the PerDUCER(R) device, guided by pericardioscopy. This device ha s a hemispherical cavity at the top of the instrument connected with a vacu um-producing syringe. In this cavity the pericardium is captured by vacuum and tangentially punctured by the introducer needle. Pericardium that can b e captured, must be up to 2 mm thin to fit into the hemispherical cavity. P ericardioscopy performed from the anterior mediastinum significantly contri buted to the success of the procedures enabling visualization of the portio ns of the pericardium free of adipose tissue or adhesions, suitable for pun cture with the PerDUCER(R). In conclusion, intrapericardial treatment of symptomatic autoreactive myope ricarditis with minimal pericardial effusion was safely and efficiently per formed in 2 patients. Pericardiocentesis was enabled by means of the PerDUC ER(R) device, facilitated by pericardioscopy.