Echocardiography-guided pericardiocentesis with probe-mounted needle: Report of 53 cases

Fifty-three pericardiocentesis procedures were performed on 48 patients fro m 1993 to 2000 at our coronary care unit. Percutaneous puncture (anterior t horacic in 43 cases, subxiphoid in 10 cases) was performed at the site clos est to the exploring probe, where the largest amount of fluid was detected. A needle carrier supported by a bracket with two fixed angulations was mou nted on the probe. The needle was advanced through the tissues and inside t he pericardial space under continuous visualization. The procedure was succ essful in 52 of 53 cases. In 1 case of diagnostic pericardiocentesis, the p ericardial space was impossible to reach because of the minimal amount of p ericardial fluid. In 1 case of acute tamponade after transcatheter ablation of the atrio-ventricular node, the pericardial puncture caused a pleural-p ericardial shunt with consequent drainage of pericardial fluid into the ple ural space and symptom resolution. In I case, a transient atrioventricular type in block occurred. Emergency surgical drainage was not required in any of the cases. No puncture of cardiac walls ever occurred in this series of patients. No major complications occurred the incidence of minor sequelae was lower than the incidence reported by other studies on pericardiocentesi s without continuous visualization. Our technique appears to be safe and ea sy to perform even in the presence of minimal amounts of pericardial fluid.