Percutaneous balloon pericardiotomy as the initial and definitive treatment for malignant pericardial effusion.
OBJECTIVE
Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions.


METHODS
Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer.


RESULTS
Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy.


CONCLUSIONS
Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches.
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. Electronic address: j.ruizgarcia@hotmail.com.
Juan
J
Ruiz-García
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Santiago
S
Jiménez-Valero
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Raúl
R
Moreno
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Guillermo
G
Galeote
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Ángel
Á
Sánchez-Recalde
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Luis
L
Calvo
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Mar
M
Moreno-Yangüela
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Sebastián
S
Carrizo
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Sergio
S
García-Blas
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
José Luis
JL
López-Sendón
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery*; D010492:Pericardiectomy / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies