[Pericardial drainage. The right indication for the right technique].
The only valid criterion for comparing surgical (or medical) techniques is the extent of the beneficial effect compared with the risk of the underlying disease. The paper on echoguided pericardial puncture published in this issue of La Presse Médicale offers an excellent opportunity to apply this criterion in an area of clinical therapeutics where the temptation to promote "minimally invasive" techniques is so great. For pericardial effusion, as for all medical conditions, it is the underlying disease which determines the long-term outcome and not the pericardial effusion itself, even in emergency situations. The objective should then go beyond symptom relief and include, when possible, a search for an etiological diagnosis. Pericardial biopsy is one element which can be contributive in a significant number of cases further adding to the beneficial effect of the surgical technique. Consequently, indications for echoguided pericardial puncture cannot be broadened beyond patients suffering from compressive pericardial effusion secondary to a perfectly recognized cause. In other less urgent situations, and when the etiology has not been identified, videoscopic techniques appear to be indicated rather than conventional surgical drainage or echoguided puncture. Other cases, such as infected or recurrent effusions, also raise specific problems requiring a careful evaluation of the expected benefit and risk of each technique. After videosurgery and videoscopy, conventional pericardial drainage, a particularly simple, rapid and effective procedure, is once again challenged by a new, more "medical" technique, emphasizing that the ever renewed story of progress in medicine must not avert our attention from the fundamental goal of combating disease.
Mazzucotelli
J
J
D004322:Drainage; D006801:Humans; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery*; D012307:Risk Factors
Drainage péricardique. A chaque technique suffit son indication....