[Ultrasound-guided pericardial drainage. Experience in 34 consecutive patients].
OBJECTIVE
Transthoracic echoguided puncture of the pericardium can be an alternative to surgical drainage. We report our experience with this technique acquired over the last 11 years.


METHODS
From January 1984 to September 1995, 34 consecutive patients in the cardiology intensive care unit (mean age 56.5 +/- 13 years) underwent echoguided 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 including 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 guidance. Intrapericardial contrast allowed verification of the catheter position. The mean quantity of 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 for 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 unrelated to the procedure after anatomic verification. In two cases, the left ventride was punctured without any consequence. Collapsus occurred during puncture in 2 patients with pulmonary sepsis. Minor incidents were: 6 vasovagal syndromes at puncture with paroxysmal supraventricular rhythm disorder during aspiration. Prior to 1988, surgical drainage was required in 5 patients for persistent or recurrent effusion. Since that time, continuous aspiration has been used in all patients and no surgical drainage has been required. Short-term prognosis depends on the underlying cause (6 deaths at 1 month).


CONCLUSIONS
Echoguided pericardial puncture is a simple procedure which rapidly improves cardiac hemodynamics in these particularly fracle patients. Continuous aspiration avoids subsequent surgical drainage for persistent or recurrent effusion.
Vayre
F
F
Service de Cardiologie, Hôpital Gilles de Corbeil, Corbeil-Essonnes.
Lardoux
H
H
Koukoui
F
F
Ollivier
J P
JP
Pezzano
M
M
D004322:Drainage / Q000009:adverse effects / Q000379:methods; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D011677:Punctures / Q000009:adverse effects
Drainage péricardique écho-guidé. Expérience chez 34 patients consécutifs.