title: [Echocardiography-guided pericardiocentesis with the apical approach].
abstract: OBJECTIVE
  We aimed to evaluate our experience with echocardiography-guided pericardiocentesis with the apical approach for pericardial effusions.
  
  
  METHODS
  We evaluated 32 pericardiocenteses performed under echocardiography guidance and with the apical approach in 29 patients (15 men, 14 women; mean age 49 years; range 18 to 72 years). Indications were diagnostic purpose, pericardial tamponade, or symptomatic pericardial effusion. Procedural success, the amount of drainage, and complications were assessed.
  
  
  RESULTS
  Common causes of pericardial effusion were malignancy (n=6), postpericardiotomy syndrome (n=5), idiopathic (n=5), chronic renal disease (n=4), and myocardial infarction (n=3). The amount of drainage was 120 ml to 2,200 ml and the duration of pericardial catheter placement in the pericardial space was 24 to 144 hours. Mortality did not occur. Echocardiographic control showed residual effusion in the lateral wall in one case, which required repositioning of the pericardial catheter for complete removal. The procedure failed in one patient due to insufficient drainage caused by multiple septations and fibrinous fluid in the pericardial space. The success rate of the procedures was 96.9%. Four cases developed hemopneumothorax requiring tube drainage, vasovagal reaction, nonsustained ventricular tachycardia, and frequent ventricular extrasystoles, respectively. Apical puncture was repeated in two cases due to erroneous left ventricular puncture and pleural catheter placement, respectively.
  
  
  CONCLUSIONS
  Echocardiography-guided pericardiocentesis with the apical approach is readily performed bedside without the need for catheterization laboratory, with a high success rate and low complication rate. It should be considered especially in cases in which anterior pericardial collection is more prominent where it will reduce unnecessary surgical interventions.
authors: Department of Cardiology, Medicine Faculty of Gaziantep University, Gaziantep, Turkey. oozer@gantep.edu.tr
authors: Hasan Orhan
authors: HO
authors: Ozer
authors: Vedat
authors: V
authors: Davutoğlu
authors: Musa
authors: M
authors: Cakici
authors: Adnan
authors: A
authors: Doğan
authors: Ibrahim
authors: I
authors: Sari
authors: Mustafa
authors: M
authors: Oylumlu
authors: Mehmet
authors: M
authors: Aksoy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000601:surgery; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis / Q000379:methods*; D011185:Postpericardiotomy Syndrome / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome