ECHOGUIDED PERICARDIAL DRAINAGE - EXPERIE NCE IN 34 CONSECUTIVE PATIENTS

OBJECTIVES: Transthoracic echoguided puncture of the pericardium can b e an alternative to surgical drainage. We report our experience with t his technique acquired over the last 11 years. PATIENTS AND METHODS: F rom January 1984 to September 1995, 34 consecutive patients in the car diology intensive care unit (mean age 56.5 +/- 13 years) underwent ech oguided pericardial puncture for poorly tolerated pericardial effusion . The underlying cause was neoplasia (n = 22), idiopathic disease (n = 5), autoimmune disease (n = 2), post-surgical complication (n = 2 inc luding 1 on hemodialysis), infection (n = 1), antivitamin K therapy (n = 1) and disseminated vascular coagulation (n = 1). The subxyphoid (n = 33) or left parasternal (n = 1) route was used under echographic gu idance. Intrapericardial contrast allowed verification oi the catheter position. The mean quantity oi fluid removed was 585 +/- 390 ml. The fluid was hemorrhagic (n = 19), clear (n = 10) or serohematic (n = 4). Aspiration was continued in 16 patients after the initial puncture fo r a mean 64 hours. The mean total Volume of fluid was 750 +/- 330 ml. RESULTS: There was one death during puncture which was found to be unr elated to the procedure after anatomic verification. In two cases, the left ventricle was punctured without any consequence. Collapsus occur red during puncture in 2 patients with pulmonary sepsis. Minor inciden ts were: 6 vasovagal syndromes at puncture with paroxysmal supraventri cular rhythm disorder during aspiration. Prior to 1988, surgical drain age was required in 5 patients for persistent tent or recurrent effusi on. Since that time, continuous aspiration has been used in all patien ts and no surgical drainage has been required. Short-term prognosis de pends on the underlying cause (6 deaths at 1 month). CONCLUSION: Echog uided pericardial puncture is a simple procedure which rapidly improve s cardiac hemodynamics in these particularly fracle patients. Continuo us aspiration avoids subsequent surgical drainage for persistent or re current effusion.