title: Safety, Efficacy, and Complications of Pericardiocentesis by Real-Time Echo-Monitored Procedure.
abstract: Pericardiocentesis is useful in the diagnosis and treatment of pericardial effusive disease. To date, a number of methods have been developed to reduce complications and increase the success rate of the procedure. The aim of the present study was to evaluate the efficacy and the safety of echocardiography-guided pericardiocentesis under continuous echocardiographic monitoring in the management of pericardial effusion. We prospectively performed 161 pericardiocentesis procedures in 141 patients admitted from 1993 to 2015 in 3 centers. This procedure was performed for tamponade or large pericardial effusion in 157 cases and for diagnosis in 4 cases. A percutaneous puncture was performed where the largest amount of fluid was detected. To perform a real-time echo-guided procedure, a multi-angle bracket was mounted on the echocardiographic probe to support the needle and enable its continuous visualization during the puncture. The procedure was successful in 160 of 161 cases (99%). Two major complications occurred (1.2%): 1 mediastinal hematoma that required surgical drainage in a patient on anticoagulant therapy and 1 pleuropericardial shunt requiring thoracentesis. Seven minor complications occurred (4.3%): 1 pleuropericardial shunt, 1 case of transient AV type III block, 3 vasovagal reactions (1 with syncope), and 2 cases of acute pulmonary edema managed with medical therapy. No punctures of any cardiac chamber occurred, and emergency surgical drainage was not required in any case. In conclusion, echocardiography-guided pericardiocentesis under continuous visualization is effective, safe, and easy to perform, even in hospitals with low volumes of procedures with or without cardiac surgery.
authors.affiliation: Cardiovascular Department, San L. Mandic Hospital, Merate, Lecco, Italy. Electronic address: maggiolinistefano@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maggiolini
authors.affiliation: Cardiovascular Department, San L. Mandic Hospital, Merate, Lecco, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Gentile
authors.affiliation: Cardiovascular Department, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Farina
authors.affiliation: Cardiovascular Department, San L. Mandic Hospital, Merate, Lecco, Italy.
authors.forename: Caterina C
authors.initials: CC
authors.lastname: De Carlini
authors.affiliation: Cardiovascular Department, A. Manzoni Hospital, Lecco, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lenatti
authors.affiliation: Cardiovascular Department, San L. Mandic Hospital, Merate, Lecco, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Meles
authors.affiliation: Department of Cardiology, San Gerardo Hospital, Monza, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Achilli
authors.affiliation: Cardiovascular Department, San L. Mandic Hospital, Merate, Lecco, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Tempesta
authors.affiliation: Division of Internal Medicine, Department of Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Brucato
authors.affiliation: Department of Cardiology, Maria Vittoria Hospital, University of Torino, Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Imazio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery*; D020519:Pericardiocentesis / Q000379:methods*; D010496:Pericardium / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult