Pericardiocentesis guided by echocardiography performed in echocardiography laboratory – Safety profile of the single center prospective registry

IntroductionPericardiocentesis is an invasive procedure for treatment of large pericardial effusion or cardiac tamponade and for diagnostics of pericardial effusion of unknown origin. Fluoroscopy navigation has been the preferred method during the past decades. Nevertheless, new imaging methods such as echocardiography emerged as an alternative guiding method for pericardiocentesis. These methods may improve safety of the procedure.MethodsAll consecutive pericardiocenteses performed in noninvasive cardiology department of a tertiary cardiovascular center during the period between 1998 and 2012 were prospectively recorded. We focused on the procedural safety and procedural success rate.ResultsDuring a 15-year period, 253 pericardiocenteses were performed in 185 patients. Most of the procedures (240 cases) were performed under echocardiographic control in our noninvasive cardiology laboratory under strictly sterile conditions and with equipment for cardiopulmonary resuscitation on site. Etiology of effusion was heart transplantation in 38 patients (25%), postoperative in 20 patients (14%), infective pericarditis in 25 patients (16%), malignancy in 18 patients (12%), and invasive procedures in 19 patients (8%). Apical approach was the most frequent in 218 patients (92%), parasternal in 13 patients (5%) and subxiphoideal in 7 patients (3%). The procedural success rate was 97% overall, with a total complication rate of 3% (2 major complications (0.3%); 7 minor complications (2.7%)). Minor complications included 2 cases of small pneumothorax, 2 cases of pericardial fluid drainage into pleural space, 2 cases of transient right chamber entries, and in 1 case the procedure was complicated by hemopericardium without the need for surgical management. Major complications included 2 cases due to ventricular perforation, one with left ventricule wall laceration in a loculated effusion and one complication due to right ventricular laceration, both resulting in hemopericardium and requiring emergency surgical repair.ConclusionEchocardiography-guided pericardiocentesis performed by echocardiologists in noninvasive cardiology department under strictly sterile conditions and with equipment for cardiopulmonary resuscitation is a safe procedure with infrequent complications. Apical entry site is safe and the dominant approach for pericardiocentesis under echocardiographic navigation.